Invisible children: an exploratory examination of child trafficking in the united states

The trafficking of children in the United States for both sex and labor is a growing phenomenon. The trafficking of humans in general is a profitable business rivaling that of the drug trade in its depth and breadth. The impact of trafficking can have sev

INVISIBLE CHILDREN: AN EXPLORATORY EXAMINATION OF CHILD TRAFFICKING IN THE UNITED STATES by Amanda Elizabeth West A dissertation submitted to the faculty of The University of Utah in partial fulfillment of the requirements for the degree of Doctor of Philosophy College of Social Work The University of Utah August 2014 Copyright © Amanda Elizabeth West 2014 All Rights Reserved The University of Utah Graduate School STATEMENT OF DISSERTATION APPROVAL The dissertation of Amanda Elizabeth West been approved by the following supervisory committee members: Caren Frost and by the College of , Chair 4/28/2014 Mary Jane Taylor , Member 4/28/2014 Lindsay Gezinski , Member 4/28/2014 David Androff , Member 4/28/2014 Aster Tecle , Member 4/28/2014 Jannah Mather Date Approved Date Approved Date Approved Date Approved Date Approved , Dean of Social Work and by David B. Kieda, Dean of The Graduate School. ABSTRACT The trafficking of children in the United States for both sex and labor is a growing phenomenon. The trafficking of humans in general is a profitable business rivaling that of the drug trade in its depth and breadth. The impact of trafficking can have severe health consequences for victims, including extreme psychological trauma as a result of their experiences. As a result, community services developed to aide in the recovery of victims of child trafficking are attempting to mitigate the impact of those experiences and return children to a life of normalcy. However, little is known about victims of child trafficking in both research and practice settings, resulting in a need to gain insights into this population. This dissertation addresses this need by exploring the experiences and observations of service providers working with victims of child trafficking in the United States. It addresses multiple aspects of child trafficking through three articles that will present findings based on three separate research studies. My gratitude goes to my partner in life, Kathy, who embodies a life filled with the idea, "leap and the net will appear." You were right. And, to all the generous hands, hearts, and minds that inspired me along the way whether you knew it or not, I am deeply indebted. TABLE OF CONTENTS ABSTRACT....................................................................................................................... iii ACKNOWLEDGMENTS ................................................................................................ vii Chapters 1 INTRODUCTION .................................................................................................. 1 Literature Overview ................................................................................................ 2 Definition of Terms................................................................................................. 4 Magnitude of the Problem in the United States ...................................................... 8 Gaps in the Literature.............................................................................................. 9 Theoretical Foundation ......................................................................................... 13 Theory of Justice ................................................................................................... 13 Intersectionality..................................................................................................... 14 Research Questions ............................................................................................... 15 Methods................................................................................................................. 16 References ............................................................................................................. 19 2 CHILD TRAFFICKING: A CONCEPT ANALYSIS .......................................... 22 Background ........................................................................................................... 22 Methods................................................................................................................. 24 Sampling the Literature......................................................................................... 26 Findings................................................................................................................. 28 Surrogate Terms .................................................................................................... 30 Attributes............................................................................................................... 30 Antecedents ........................................................................................................... 33 Consequences ........................................................................................................ 34 Discussion ............................................................................................................. 36 Theoretical Definition ........................................................................................... 38 Limitations ............................................................................................................ 38 Summary ............................................................................................................... 39 References ............................................................................................................. 39 3 WHAT THE HELPER KNOWS: VICTIM RESISTANCE AND THE EXPERIENCES OF SERVICE PROVIDERS WORKING WITH CHILD TRAFFICKING VICTIMS................................................................................... 42 Introduction ........................................................................................................... 42 Methods................................................................................................................. 45 Sample and Data Collection.................................................................................. 45 Analysis................................................................................................................. 48 Results ................................................................................................................... 50 Discussion ............................................................................................................. 59 Limitations ............................................................................................................ 68 Conclusion ............................................................................................................ 68 References ............................................................................................................. 69 4 THE CHILD WELFARE RESPONSE TO CHILD TRAFFICKING: VIEWPOINTS OF SERVICE PROVIDERS WORKING WITH CHILD TRAFFICKING VICTIMS................................................................................... 71 Introduction ........................................................................................................... 71 Background ........................................................................................................... 71 Methods................................................................................................................. 75 Sample and Data Collection.................................................................................. 75 Results ................................................................................................................... 78 Discussion ............................................................................................................. 85 Limitations and Future Research .......................................................................... 88 Conclusion ............................................................................................................ 89 References ............................................................................................................. 89 5 CONCLUSION ..................................................................................................... 92 Overview ............................................................................................................... 92 Theoretical Considerations ................................................................................... 93 Concept of Child Trafficking ................................................................................ 95 Service Provider Experiences and Victim Resistance .......................................... 95 Service Provider Experiences and Child Welfare ................................................. 96 Future Community Responses .............................................................................. 96 Practice, Policy, and Future Research................................................................... 99 Clinical Implications ........................................................................................... 100 Policy Implications ............................................................................................. 101 Future Research .................................................................................................. 102 References ........................................................................................................... 103 Appendices A SERVICE PROVIDER INTERVIEW GUIDE .................................................. 104 B SERVICE PROVIDER SURVEY DEMOGRAPHICS ..................................... 105 vi ACKNOWLEDGMENTS There are many people to thank for their generosity in supporting the completion of this dissertation. First and foremost is my chair, sounding board, and coach, Dr. Caren Frost. This work is a direct result of your guidance, patience, generosity of time, thought, and encouragement. I am grateful to my committee members who challenged me and offered their wealth of expertise and knowledge in helping me to be my best: Drs. Mary Jane Taylor, Lindsay Gezinski, David Androff, and Aster Tecle. My thanks extend to Norma Harris, whose watchful eye and wisdom steered me along a true path. And, to my special friends and family members who listened and supported, but kept pushing on thank you. CHAPTER 1 INTRODUCTION Child trafficking in the United States is a topic about which little is known. Based upon estimates from the research on human trafficking (HT) in general, the United States is the second most common country of destination after Germany for victims of trafficking globally (Schauer & Wheaton, 2006). It is estimated that the trafficking of human beings will surpass drug trafficking as a major economic force within the next 10 years. Women compose 80% of all victims of trafficking with half of those female victims being under the age of 18 (Estes & Weiner, 2001). Traditional child welfare services, designed to meet the needs of children abused and neglected by family members or single perpetrators, are not equipped and/or staff are not trained to address the unique needs of the trafficked population (Fong & Cardoso, 2009). This dissertation will include three articles that explore (a) the content of the literature around child trafficking, (b) the experiences and observations of service providers working with victims of child trafficking, and (c) policy and service implications for the field of social work based upon the experiences of service providers and former victims in the United States. Child trafficking is an international phenomenon with many foci within the literature, such as child labor practices, indentured servitude, child fostering, the impact of globalization, and the absence of child welfare systems (Goździak, 2008). However, the focus of this research is specific to the United States and the unique attributes and responses of child 2 welfare services and the perceptions and experiences of service providers working with victims of child trafficking. Literature Overview Human trafficking, also known as modern-day slavery, is a crime and violation of human rights that is fueled by an extensive criminal economic market (Schauer & Wheaton, 2006). The trafficking of humans provides profit to individuals, companies, communities, and countries through the exploitation of human beings, as well as the deprivation of human rights through creation of an underground economic market for free labor. The majority of research regarding human trafficking focuses on adults rather than children (Fong & Cardoso, 2009). This focus on adult trafficking exists in spite of the estimate that the human trafficking of individuals under the age of 18 is estimated to include 1.2 million children each year (International Labour Organization, 2002). Services specific for children of trafficking would look quite different than that of the typical community services for those who are neglected and/or physically and sexually abused. For example, the lack of specific programming regarding child victims creates a void that can result in children unknowingly being funneled into systems of care, such as juvenile justice services, that are not in the best interest of this population. Due to lack of identification as trafficking victims rather than underage prostitutes, the existing systemic structures may treat victims as criminals in contrast to victims of exploitation and coercion. This lack of identification may further traumatize victims due to the lack of professional training and skills needed to understand the complex needs of these victims (Ferguson, Soydan, Lee, Yamanaka, Freer, & Xie, 2009). 3 Children who are trafficked have specific needs related to trauma. Child trafficking, which often includes sexual assault and exploitation, may infer the need for extensive medical and mental health treatment due to the physical and psychological trauma these youth have experienced as a result of the physical abuse, torture, and sexual assaults that they have endured in captivity (Ferguson et al., 2009). As with the larger population of child trauma victims, the presentation and depiction of abuse presented by the child may change over time and according to culture. This trauma presentation may result in a lack of understanding from professionals not trained in the dynamics of child trafficking and child trauma in general (Ferguson et al., 2009). Child welfare responses to child trafficking victims are those designed to meet the needs of children who are neglected, physically abused, and sexually abused by individual families rather than multiple perpetrators (Fong & Cardoso, 2009). This important distinction is necessary in understanding the complexity of trauma and neglect that child victims have undergone. Without an understanding of the complex nature of child trafficking circumstances, victims are at-risk of being marginalized further through a lack of appropriate services, policies, and legal responses. Treatment-specific challenges exist due to the lack of training and accurate identification of child trafficking victims. There are a very limited number of treatment interventions for child victims of HT that have been studied within a best practices framework, leaving this group's mental health care to fit within existing modalities that are aimed at traditional child abuse such as individual, group, and family psychotherapy (Fong & Cardoso, 2009). Without a comprehensive understanding of the variables involved in child trafficking, victims remain extremely vulnerable to being victimized 4 again by the human services system itself because of a lack of training and knowledge by professionals who may not understand the unique and complex needs of this population (Ferguson et al., 2009). Therefore, research in the area of child trafficking is needed to learn more about the specific needs of child victims and also to inform social work practice and interventions designed to address the needs of these children. Definition of Terms In 2010, the United Nations defined HT as: The recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal of organs. (United Nations Office on Drugs and Crime, 2011) Consensus for a definition of HT from the United Nations took considerable effort. The cultural views about sex and labor have a great impact on what is considered a violation of a human right or a natural consequence of a lack of economic and employment opportunities. In addition, there was hesitation from countries that directly benefit from certain types of human rights abuses to include them in an international definition of HT (Buckland, 2008). Therefore, the creation of a trafficking definition that garnered international support was no small feat. The cultural implications are crucial to understand when discussing trafficking either within United States boundaries or when boundaries are crossed. Cultural definitions of "woman," "child," "virginity," "slavery," and "debt bondage" can be as diverse as the words themselves, and it is with a 5 multidimensional lens that the discussion of HT must be viewed when discussing the trafficking of individuals into the United States (Chung, 2009; Goździak, 2008). In the late 1990s, the United States took the lead among high-income countries in defining trafficking and establishing a protocol of protections for victims. This act, called the Trafficking Victims Protection Act (TVPA), was created and implemented under the Clinton Administration in 2000 and applies to non-United States citizens or permanent residents (Goździak & MacDonnell, 2007; Potocky, 2010). Under the TVPA, the United States defines trafficking as: 1. Sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or 2. The recruitment, harboring, transportation, provision or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. Under the TVPA, transportation or physical movement does not need to be present for a crime to occur and not all of these elements appearing in the definition need to be present; however, the element of exploitation to unfairly profit from one's acts does. Within the literature, the key words of "force," "fraud," or "coercion" are referenced under the TVPA to define the occurrence of a crime in the case of sex trafficking of adults in addition to other labor and services. Within the legislation for the TVPA, the United States also established a tiered rating system to assess what prevention activities other countries were taking to deter and/or abolish HT (Desyllas, 2007). Tier one 6 countries consist of governments who fully comply with minimum standards to combat trafficking established in the TVPA (i.e., Australia, France, Germany). Tier two countries consist of governments who may not meet the minimum standards of the TVPA but have made considerable progress and taken initiative to meet the standards (i.e., Mexico, Brazil, Albania). Tier two countries are then placed on a "watch list" to examine their efforts within the year towards meeting minimum standards and taking significant steps to decrease trafficking in their countries. Tier three countries consist of governments who do not meet the minimum standards of the TVPA and are not making significant efforts to become compliant (i.e., North Korea, Syria, Sudan). Tier three countries are then penalized monetarily through the restriction of U.S. government foreign assistance and will encounter U.S. opposition to any monetary assistance requested of the International Monetary Fund and the World Bank (United States Department of State, 2012). This tiered ranking system does not go without controversy, as smaller and less powerful countries are dictated to by higher income countries that often help to create the global economic situations in which HT is found (Kempadoo, 2007). Child trafficking specifically refers to trafficking that includes the involvement of boys and girls under the age of 18 in any labor or sex practice. As opposed to the definition for adult HT, the key concepts of force, fraud, and coercion do not need to be present in the case of child trafficking. Child trafficking most often occurs when the child knows his/her trafficker as a relative or family friend prior to becoming victimized (Goździak, Bump, Duncan, MacDonnell, & Loiselle, 2006). In the majority of cases, victims of child trafficking are deceptively lured into contact with their traffickers. 7 Promises are made under the pretenses of working for money for a better life and to help their families. Alongside the discussion of child trafficking is the concept of smuggling, which is interrelated with HT. The key difference between smuggling and trafficking is that smuggling typically involves a short-term monetary gain while trafficking involves an unlimited source of profit for the life of the victim (Aronowitz, 2001). Additionally, smuggling can be defined as a form of irregular migration where an individual leaves a country willingly to be escorted illegally by another individual into another country. In contrast, the trafficking of an individual does not require movement or traveling (Aronowitz, 2001). In many cases, what begins as smuggling ends up as HT. In the case of children, both United Nations and United States policies indicate that children are trafficked regardless of whether the (1) original crime originated from smuggling or direct trafficking and (2) child consented to the coercive efforts made to assist them in migrating for work. The criminal nature of smuggling is established due to the fact that children do not have the ability to consent and are considered victims of both crimes. Therefore, smuggling is not differentiated as separate from HT under international and domestic policies and laws when children are involved (Goździak, 2008). Being a victim of child trafficking in the United States, unlike being an adult victim of trafficking, allows a child to be protected under legislation and receive protections to which adult victims do not automatically have access. For example, under the TVPA in the United States, a child may receive a T-Visa without cooperating with law enforcement. A T-Visa gives an individual temporary status and employment 8 authorization in the United States for 4 years and allows victims to receive the same services and benefits as refugees (Potocky, 2010). However, the complexity of the legal and human service systems still greatly limits the avenues to receiving help and lessens the likelihood that nongovernmental global organizations (NGO) or other human service entities with direct contact with trafficked children could access this protection. Also unique to the experience of a trafficked child is contact with the Office of Refugee Services as an unaccompanied minor for international victims, and involvement with child welfare and juvenile justice services, which are all exclusive experiences of child victims. Lack of systemic coordination among a complexity of agencies and policies only adds to the barriers faced by child victims. Magnitude of the Problem in the United States The United States State Department estimates that up to 800,000 people are trafficked every year over all international borders and that half of those victims are under the age of 18 (United States Department of Health and Human Services, 2009). Looking specifically at the United States itself, it is estimated that at least 17,000 children, 18 years old and under, are trafficked across the border each year and 100,000 children are victims of domestic minor sex trafficking (Estes & Weiner, 2001; Smith, Healy Vardaman, & Snow, 2009). Due to the fact that it is conducted within an underground and criminal market, it is extremely difficult to calculate the exact number of victims based on empirical evidence. This gap is in part due to the inability of victims to come forward even when given a chance as a result of threats to themselves and their families, lack of access to documentation, and/or a fear of law enforcement (Bales, 2004). The actual scope of HT is widely debated within the research community while some 9 believe that the published number of victims by the United States State Department is grossly underestimated, and others believe it is inflated (Schauer & Wheaton, 2006). The identification of child trafficking victims remains a daunting and complicated task. In 2012, the Office of Refugee Resettlement (ORR), which is charged with issuing eligibility letters for unaccompanied minors for federally funded foster care, reported serving a total number of 13,625 children within the overall Unaccompanied Refugee Minors program; however, only 90 letters of eligibility were written for unaccompanied children who were identified as victims of trafficking (United States Department of Health and Human Services, 2012). This low number of identified child trafficking victims is believed to be based in the complex systemic navigation required to access benefits through the ORR and the difficulty in referring victims for services, which must be completed directly by federal law enforcement to receive HT protective status (Goździak & MacDonnell, 2007). Since the implementation of the Homeland Security Act (HSA) of 2002, it is estimated that every year, 100,000 unaccompanied children are taken into temporary or long-term custody each year. Approximately 8,000 children remain in United States federal custody each year and there is a very high possibility that many of these children are victims of trafficking but have not been identified as such (Goździak & MacDonnell, 2007). Gaps in the Literature Many authors in the field of HT discuss weaknesses in the current literature. One of these weaknesses is the lack of access to the population of HT victims (Brunovskis & Surtees, 2010; Tyldum, 2010). Not only do they rarely seek help through law enforcement or human service providers, HT victims are not visible to the public and are 10 hidden within a world of underground and organized crime (United States Department of Health and Human Services, 2009). Often HT victims are not able to escape from their captors, and even when opportunities to leave are possible, it is not anticipated that all victims would choose to escape. Fear of retaliation and/or fear of death of family members in their country of origin, and/or lack of personal documentation such as birth certificates or passports, precludes many victims from coming forward for help (Bales & Soodalter, 2009). Without legal documentation, trafficking victims may be treated as undocumented workers, resulting in deportation or other legal consequences. Unique to sex trafficking victims is societal shaming and ostracism of females after experiencing rape and other sexual assaults, diminishing their motivation to request help due to cultural values and social constructs of "female" and "virginity" (Brunovskis, 2010). The majority of research conducted about human trafficking focuses on women, which is the result of an increased concern about sexual exploitation and the estimate that the majority of victims of HT are female. Research focused on other types of HT such as hard labor, organ removal, and a general lack of focus on men and boys creates a void in the literature on human trafficking (Goździak, 2005). The literature also suggests that the overwhelming focus on sexual exploitation of both women and children serves to deflect and prevent a deeper examination of the economic contribution and demand for HT both nationally and internationally. It is suggested that by sensationalizing and deflecting the focus to sexual exploitation, the effects of globalization and forced migration are avoided and dismissed and actually allow the states to pursue projects under the guise of concern and protection for its citizens, such as policies surrounding increased border control and immigration enforcement (Berman, 2010). 11 To further understand the focus on sex trafficking, it is important to examine the battle between two competing philosophies regarding the nature of sex work and the sexual exploitation of women. The two ideological camps at opposition are abolitionists (now being referred to as prohibitionists) who believe that any type of sex work, even if it is consensual, is human trafficking and that societal and cultural circumstances, such as poverty for example, force women into prostitution due to an absence of other options. Through this lens, women are viewed as being unable to make choices to participate in sex work of their own free will and are always coerced either through societal circumstances or by others (Desyllas, 2007). On the other end of the spectrum is the sex workers' rights approach, which takes into account that prostitution can be a practical option for women to survive and believe women can and do make choices to participate in sex work. However, promoters of this view also believe that this work should be regulated and safeguards put in place to promote the health of the sex worker and eliminate the existence of violence and unsafe working conditions (Desyllas, 2007; Logan & Hunt, 2009). Harm reduction models emphasizing the environment and social context connected to the issue causing harm are a direct connection to this theoretical approach (Androff, 2010). Another area of controversy within the literature concerns the larger concept of irregular migration as a whole. HT is but one type of irregular migration because smuggled individuals and asylum seekers are also migrants. The discrepancy in treatment between HT victims and those who are smuggled becomes a larger issue within the literature when one begins to explore the similar circumstances and outcomes of individuals who agree to be smuggled into other countries, yet in the end are not 12 considered "victims" but "criminals" and are not permitted to define this for themselves based on their experiences (Buckland, 2008). In both scenarios, people are living in conditions and situations in which they have limited opportunities for income and a better life, and view migration to another country as the only option they have. However, in the case of HT, people treat victims of HT with much more accepting and protective policies around their circumstances as opposed to those who may have suffered many of the same abuses during their migration journeys (Aronowitz, 2001). The literature emphasizes that the only research participants who are able to participate in studies of HT are those who have survived and are not currently being victimized. This research hurdle is due to the ethical issues encountered in research conducted with a person currently experiencing abuse, exploitation, or imprisonment who first and foremost requires legal intervention and the provision of rehabilitation services (Tyldum, 2010). Risk to the researcher also becomes a significant concern due to the potential exposure and association with traffickers and organized crime markets. Additional weaknesses in the research include unrepresentative samples, limited access to respondents, selection biases, and self-selection by respondents (Brunovskis, 2010). The outcome of these gaps results in an extremely low number of research studies that are conducted or published. Furthermore, the articles that are published are most often overviews, commentaries, and policy analyses rather than studies based on empirical evidence (Goździak, 2005). As mentioned earlier, child welfare services are designed to meet the needs of children who have been abused and neglected by individual perpetrators and families rather than multiple perpetrators. Therefore, research in the area of child trafficking is 13 needed to learn more about the needs of child victims and also to inform social work practice and services designed to accommodate these children. Without a comprehensive understanding of the variables involved in child trafficking, victims remain extremely vulnerable to being victimized again by the human service and law enforcement systems (Ferguson et al., 2009). Theoretical Foundation Rawls' Theory of Justice and the theory of Intersectionality will be utilized for the research questions addressed in this dissertation. As guiding frameworks for this research, these two theories will provide a lens for elements such as interview questions, data analysis, and theme development. It is also believed that these theories complement each other in their look at both the macro and micro influence of societal functions and social identities related to inequality and oppression. Theory of Justice In his (1993) essay, Law of Peoples, Rawls expands upon his Theory of Justice and specifically addresses the role of free and democratic peoples in addressing "burdened peoples" and honoring human rights (Rawls, 1993). In Rawls' essay, human rights are believed to be politically determined within a societal context and require that an individual be only a responsible and cooperating member of society who can recognize and act in accordance with his/her moral duties and obligations (Rawls, 1993). This Theory of Justice provides a consistent structure for viewing a social phenomenon such as child trafficking by shaping our view of society to one that acknowledges that the success or happiness in one's life is only partly due to individual efforts and that the basic 14 structure of society and social institutions also influence one's life (Lovett, 2011). In the case of the current research on child trafficking, research questions based on this theory will examine society's role in the application of concepts such as fairness, equality, and liberty as they apply to the experiences of victims and the experiences of service providers working with victims. These concepts will also further aid in analyzing the development and implementation of services for this population. The assumptions and arguments suggested by the Theory of Justice are based on the premise that the structure of a just society would be by agents who are motivated, open-minded, and rational. Therefore, just and fair principles will result (Lovett, 2011). Within the Theory of Justice, concepts such as equal and basic liberties, social and economic inequalities, and the distribution of goods are thoroughly examined under the premise that the disadvantaged are to be uplifted to an equal advantage as others in society (Lovett, 2011). This theory helps to guide the current research by complimenting the social work values of social justice and focusing on oppressed populations. Ideas, such as the profitability of child trafficking at the expense of the victims from an economic viewpoint, can be considered within Rawls' theory in addition to the application of the concepts of fairness, equality, and liberty in their life experiences. Intersectionality Intersectionality is a feminist framework that examines inequality from the multiple realities of an individual with a specific emphasis on social, cultural, and biological identities within a population (McCall, 2005). In this way, each identity contributes to the research process by guiding the researcher through differing assumptions about the nature of reality, but varies in their degree of specificity. 15 Intersectionality sees relationships as existing along multiple dimensions and types of social relations (McCall, 2005). By choosing this theory, the current research will examine the consequences of the interaction between two or more systems of oppression such as based on gender, economic, and political status. Those systems can then be related to child trafficking through the exploration of various forces that victims must navigate such as, human services, law enforcement, and the legal system (Yuval-Davis, 2006). Intersectionality posits that there must be an examination of inequalities from the perspective that each individual has different experiences, culture, abilities, gender, and biological identifiers that will differentiate their needs and standpoints in the world (McCall, 2005). Through an intracategorical approach, this theory will be utilized to explore existing social divisions as they relate to an individual's social experience and his/her experience of child trafficking either as a victim or service provider. An intracategorical approach acknowledges the importance of social categories in relation to a person's experiences and aims to focus on individuals who live in more than one category to construct an ideal of understanding of human experience (Bhattacharya, 2012). This theoretical perspective is especially useful in examining child trafficking as it takes into account unique contributors for each individual that may have led to his/her exposure to trafficking, his/her usage of services, and the potential benefits received from services within the field of social work. Research Questions Based on the summary of the literature noted above, this dissertation addresses the following questions: 16 • How is the concept of child trafficking created and socially constructed within the social science literature? • What are the experiences, perceptions, and knowledge base of service providers who work with child trafficking victims? • How can the experiences of service providers working with child trafficking victims shape child welfare policy and intervention? Methods A series of three articles relating to child trafficking will be written as part of this dissertation. This dissertation uses the multiple article path (MAP) wherein Chapters 2 to 4 will be individual publishable articles. The foci of all three articles for this dissertation are qualitative and exploratory since the current research within child trafficking is still developing and much about the needs of victims remains unclear at best. Thus, I used a grounded theoretical approach for the last two articles, which did not begin research with a hypothesis, but rather developed a relationship between theory and data once the data had been collected. Grounded theory consists of systematic, yet flexible guidelines for collecting and analyzing qualitative data to construct theories grounded in the data themselves (Charmaz, 2010). A grounded theoretical approach was used in the last two exploratory articles on child trafficking. Therefore, processes, themes, and relationships were noted and examined throughout the interview process, transcription, coding, and interpretation. These processes were then analytically described and interpreted with the use of data management software program, Atlas.ti. Due to the fact that this theoretical approach emerged from the data, the approach was more fully discussed in the later portion of each article where findings were fully explored. 17 The first article, titled A concept analysis of child trafficking, analyzed the current scientific literature regarding how the concept of child trafficking is developed and communicated on a global level. This employed a systematic and qualitative search of the chosen disciplines of law and social work with the goal of including perspectives from multiple levels, such as macro, mezzo, and micro frameworks. This systematic review entailed the analysis of academic journal articles from the years 2003 to 2013. From the result of the key terms used for the article search, either 20% or 30 articles were analyzed, whichever was greater. Rodger's evolutionary method of analysis was employed and discussed within the parameters of surrogate terms, attributes, antecedents, and consequences (Tofthagen, 2010). The goal of the analysis was to provide a greater understanding of the actual global concept of child trafficking as it currently exists. From this, theory can continue to develop surrounding the concept and aid in the research of the following two articles in this dissertation by lending a comprehensive social understanding of child trafficking. The second article explored the experiences, perceptions, and knowledge base of service providers who work with victims of child trafficking. The purpose of this article is to gain an understanding of the insights, observations, and skills of those who work with a population and social phenomenon about which little is known. The literature review for this article included both past and present research related to service providers from both a domestic and international perspective. The methodology for this study entailed in-depth interviews with service providers and a grounded theory qualitative analysis of data collected. Data were analyzed using coding and the production of themes through the use of the qualitative software Atlas-ti., a data management software 18 program. Snowball sampling was employed as the sampling method for this study, starting with identified social service leaders within the child trafficking community who were associated with agencies and foundations with direct client contact, resulting in 15 participants. Individual participant interviews took place in-person at a location of the participant's choosing and took approximately 60 minutes per interview. IRB approval was obtained for this research. A semistructured interview guide for this study included theory-guided questions pertaining to the experiences and perceptions of service providers as well as general questions exploring the experiences of service providers (Appendix A). In addition, a brief demographic survey was given prior to conducting the interview and these data were presented through the use of descriptive statistics (Appendix B). The third article considered how the experiences and insights of service providers could be utilized to shape research policy and service delivery in the field of social work. The data for this article were drawn from the interviews and demographic data collected from service providers from the second study. The data from the interviews conducted for the second study were analyzed to determine how the experiences of service providers could inform policy and intervention development. As discussed earlier, services available to victims of child trafficking are designed for traditional victims of abuse and neglect that is often seen by an individual or familial perpetrator. The child welfare system is ill equipped in both training and in the provision of direct services to address and provide interventions for this population. The current child welfare system has traditionally served child victims of abuse and trauma from the stance of a familial perpetrator. The experiences of child trafficking victims do not necessarily fit within 19 these confines. Therefore, an understanding of the experiences of the service providers working with victims is needed in order to inform and shape future services and supporting policies. References Androff, D. (2010). The problem of contemporary slavery: An international human rights challenge for social work. International Social Work, 54(2), 209-222. Aronowitz, A. (2011). Smuggling and trafficking in human beings: The phenomenon, the markets that drive it and the organizations that promote it. European Journal on Criminal Policy and Research, 9, 163-195. Bales, K. (2004). Slavery and the human right to evil. Journal of Human Rights, 3(1), 53-63. Bales, K., & Soodalter, R. (2009). The slave next door: Human trafficking and slavery in America Today. Los Angeles: University of California Press. Berman, J. (2010). Biopolitical management, economic calculation and "trafficked women." International Migration, 48(4), 84-113. Brunovskis, A., & Surtees, R. (2010). Untold stories: Biases and selection effects in research with victims of trafficking for sexual exploitation. International Migration, 48(4), 1-37. Buckland, B. (2008, March-May). More than just victims: The truth about human trafficking. Public Policy Research, 42-47. Charmaz, K. (2010). Constructing grounded theory: A practical guide through qualitative analysis. Los Angeles, CA: Sage. Chung, Rita C.-Y. (2009). Cultural perspectives on child trafficking, human rights & social justice: A model for psychologists. Counseling Psychology Quarterly, 22(1), 85-96. Desyllas, M. (2007). A critique of the global trafficking discourse and the United States policy. Journal of Sociology & Social Welfare, 34(4), 57-79. Estes, R., & Weiner, N. (2001) The commercial sexual exploitation of children in the United States, Canada and Mexico. Philadelphia, PA: University of Pennsylvania School of Social Work. Ferguson, K., Soydan, H., Lee, S., Yamanaka, A., Freer, A., & Xie, B. (2009). Evaluation of the CSEC Community Intervention Project in five U.S. cities. Evaluation Review, 33(6), 568-597. 20 Fong, R., & Cardoso, J. (2009). Child human trafficking victims: Challenges for the child welfare system. Evaluation and Program Planning, 33, 311-316. Goździak, E. (2008). On challenges, dilemmas, and opportunities in studying trafficked children. Anthropological Quarterly, 81(4), 903-923. Goździak, E., Bump, M., Duncan, J., MacDonnell, M., & Loiselle, M. (2006). The trafficked child: Trauma and resilience. Forced Migration Review, 25, 14-15. Goździak, E., & Collett, E. (2005). Research on human trafficking in North America: A review of literature. International Migration, 43(1/2), 99-128. Goździak, E., & MacDonnell, M. (2007). Closing the gaps: The need to improve identification and services to child victims of trafficking. Human Organization, 66(2), 171-184. Kempadoo, K. (2007). The war on human trafficking in the Caribbean. Race and Class, 49(2), 79-85. Logan, T., & Hunt, G. (2009). Understanding human trafficking in the United States. Trauma, Violence, & Abuse, 10(1), 3-30. Lovett, F. (2011). Rawls's a theory of justice. New York, NY: Continuum International. Perrin, B. (2010). Just passing through? International legal obligations and policies of transit countries in combating trafficking in persons. European Journal of Criminology, 7(1), 11-27. Potocky, M. (2010). Effectiveness of services for victims of international human trafficking: An exploratory evaluation. Journal of Immigrant & Refugee Studies, 8, 359-385. Rawls, J. (1993). The law of peoples. Critical Inquiry, 20(1), 36-68. Schauer, E., & Wheaton, E. (2006). Sex trafficking into the United States: A literature review. Criminal Justice Review, 31(2), 146-169. Segrave, M. (2009). Order at the border: The repatriation of victims of trafficking. Women's Studies International Forum, 32, 251-260. Smith, L. A., Healy Vardaman, S., & Snow. M. A. (2009). The national report on domestic minor sex trafficking: America's prostituted children. Retrieved from the Shared Hope International website: http://sharedhope.org/wp-content/uploads /2012/09/SHI_National_Report_on_DMST_2009.pdf Tofthagen, R., & Fagerstrøm, L. (2010). Rodgers' evolutionary concept analysis: A valid method for developing knowledge in nursing science. Scandinavian Journal of Caring Sciences, 24, 21-31. 21 Tyldum, G. (2010). Limitations in research on human trafficking. International Migration, 48(5), 1-13. Ugarte, M., Zarate, L., & Farley, M. (2003) Prostitution and trafficking of women and children from Mexico to the United States. Journal of Trauma Practice, 2(3/4), 147-166. United Nations Office on Drugs and Crime. (2012). What is human trafficking? Retrieved from http://www.unodc.org/unodc/en/human-trafficking/what-is -human-trafficking.html U.S. Department of Health and Human Services. (2009). Human trafficking into and within the United States: A review of the literature. Washington, DC: Author. U.S. Department of Health and Human Services/Office of Refugee Resettlement. (2011). Report to Congress, fiscal year 2008. Washington, DC: Author. U.S. Department of Health and Human Services/Office of Refugee Resettlement. (2012). The year in review, 2012. Washington, DC: Author. U.S. Department of State. (2012). Trafficking in Persons Report. Washington, DC: Author. Wheaton, E., Schauer, E., & Galli, T. (2010). Economics of human trafficking. International Migration, 48(4), 114-141. CHAPTER 2 CHILD TRAFFICKING: A CONCEPT ANALYSIS Background The increasing social awareness and academic attention focused on the issue of child trafficking continues to develop and transform; however, an exploration of the concept of child trafficking is lacking in the literature. Human trafficking, or modern-day slavery, is estimated to be among today's fastest growing criminal markets, only behind that of drug and weapons trafficking. It is also estimated that within the next decade, human trafficking will surpass drug and weapons trafficking as the most lucrative criminal market (Miko & Park, 2002; Schauer & Wheaton, 2006). This shift, in part, is due to minimal legal consequences associated with human trafficking compared to the legal penalties associated with drug and weapons trafficking (Chung, 2009). Adding to the profitability of human trafficking is the ongoing revenue stream that victims provide for traffickers over a significant period of time in comparison to the one-time monetary exchange present with the selling of drugs and weapons (Jordan, Patel, & Rapp, 2013). In addition, there currently exists a surplus of people who are vulnerable to trafficking, therefore decreasing the initial monetary cost to traffickers (Androff, 2010). Child trafficking, or the human trafficking of individuals under the age of 18, is estimated to include 1.2 million children each year (International Labour Organization, 2002). It is difficult to accurately account for the exact number of children living within 23 trafficking conditions due to an underdeveloped data collection methodology for the calculation of this largely underground criminal enterprise and the reluctance or inability of victims to come forward for help. It is estimated, however, that there are 27 million victims of overall human trafficking in current existence with the vast majority of these victims being women and children (Jordan, Patel, & Rapp, 2013). Child trafficking includes activities such as domestic labor, hard labor, and sex trafficking. While they are not new to the current body of knowledge, these concepts are now gaining a social response not only from local communities but from policy-makers as well. Due to this increased societal knowledge and growing response, a concept analysis of child trafficking provides a direct and holistic investigation of meanings both direct and indirectly associated with child trafficking that form a common understanding. With this shared understanding of the concept as a whole and not just as a shared definition, societal discussions and interventions can grow in a cohesive and robust manner. As awareness of child trafficking increases, it is hoped that both social and legal interventions will increase. For example, in the United States, new laws, referred to as Safe Harbor laws, are being created in various states. These laws automatically treat children engaged in prostitution as victims of child sex trafficking rather than criminals, sending a less stigmatizing message to victims and affording them treatment and services otherwise not accessed through a criminal setting (Bergman, 2012). With this example, one can see that language and the meaning associated with that language have the capacity to alter a victim's treatment course. In this article, a concept analysis will not only examine the many components connected to child trafficking in order to add to 24 scientific knowledge, but more importantly to accurately communicate a shared understanding of the concept of child trafficking. It is hoped that through a common understanding of child trafficking, both social work research and practice can more effectively communicate efforts to impact this phenomenon. Using an inductive, evolutionary method of concept analysis, the purpose of the current article is to investigate the meaning of child trafficking within the context of the current social science literature. A concept analysis is required in order to comprehensively understand the concept that will be the focus of future research in the field. A concept analysis is the primary building block for the continuation of meaningful research and the development of theory (Botes, 2002). In this instance, a concept analysis is required in order to holistically understand child trafficking, which will be the focus of future research in the field of social work. Methods As stated earlier, one of the aims of this research was to aide in the holistic understanding and usage of the concept of child trafficking with the goal of cohesively informing those who have the ability to effect social change regarding this phenomenon. In a dispositional view, meaning is found in the use of words. Words do not possess a meaning in and of themselves, but instead, meaning is formed in the usage of the words (Baldwin, 2008). Baldwin (2008) explains that concepts are to be viewed as expressed abstractions repeated in social interactions with which common attributes begin to be associated. As a result, Rodgers' evolutionary method of concept analysis was employed for this article to provide a dispositional view of child trafficking rather than an entity 25 view, which Rodgers emphasizes is used in advancing the logical and finite elements of the positivist movement (Baldwin, 2008). According to Rodgers (2000), the following is used to further describe and differentiate the evolutionary model: In the evolutionary approach the emphasis is on the inductive inquiry and rigorous analysis, rather than beginning the investigation with the researcher's own preconceived ideas of the concept… it represents the radical departure from other approaches…in this approach concepts are not seen as static, timeless entities with identifiable boundaries…the results do not reveal precisely what a concept is or is not…it is consistent with the idea of a cycle providing the clarity necessary to create a foundation for further inquiry and development. (p. 84) The evolutionary method of analysis includes the identification of a concept and surrogate terms, identifying an appropriate setting and sample for data collection, collection of data, analysis of the data, the identification of an exemplar of the concept if needed, and implications for future development of the concept (Rodgers, 2000). Concept identification The concept of child trafficking may be understood in different settings and through a diverse number of disciplines with differing attributes and lenses. Rodgers (2000) reminds us that, "… a concept is not a word, but the idea or characteristics associated with the word. Words are used to express concepts; they are not the concepts themselves" (p. 85). When sampling the literature on the concept of child trafficking, surrogate terms such as child slavery, commercial sexual exploitation of children, child abuse, and child prostitution suggested alternative options for communicating the concept of child trafficking. The choice of appropriate search terms is especially important when beginning an analysis as Rodgers (2000) explains: 26 One of the most common ways of expressing a concept is through written or spoken language. Consequently, the major focus at the beginning of the study is to determine the concept of interest and appropriate terminology to guide the analysis. (p. 85) Sampling the Literature In this research, the setting is characterized by the time period in which the literature search was conducted and the disciplines chosen for exploration and further concept construction. Scholarly literature in law, psychology, and social work was identified for the years 2003 to 2013, because these disciplines aid in the expansion of knowledge regarding the concept of child trafficking. These fields demonstrate a diverse range of disciplinary views, while at the same time, each playing an important role in the current literature. The search was further defined by the use of Legal Collection and PsycINFO databases. The search terms utilized included child trafficking, child slavery, domestic minor sex trafficking, and commercial sexual exploitation of children. These search terms were chosen based upon their usage within the popular scientific literature and seminal pieces of work in the field of child trafficking. During a systematic search of the literature, 70 articles were identified within the specified databases (see Figure 2.1). Rodgers (2000) suggests retrieving at least 30 articles from the sample when possible, or 20% of the total population, whichever is greater, to insure that the resulting data reflect a sample of diverse information. To further develop the sample from the 70 articles, article abstracts were scanned for the originally specified search terms that are frequently found in the media and general scientific literature searches on child trafficking. The use of a random number generator was then used as needed to further narrow the sample size as appropriate. While reviewing the 27 Figure 2.1. Flow diagram 28 identified sample, attention was given to surrogate terms, contextual uses of the concept, and related concept attributes (Figure 2.1). A total of 30 articles were reviewed since 20% of the sample would have been smaller than the ideal 30-article sample. Rodgers (2000) suggests the inclusion of landmark or commonly cited works, as well, and as a result, this study included four writings by Estes and Weiner (2001), Goździak (2008), Logan and Hunt (2009), and Miko and Park (2002)-thus a total of 34 articles were reviewed. Findings Among the diverse uses of the concept of child trafficking, there were common expressions indicating that child trafficking was illegal, immoral, and also common. In the exploration of the concept of child trafficking was the increased discussion and focus on the sex trafficking of children rather than other forms of trafficking, such as labor trafficking of children. As noted in Table 2.1, there are four distinct categories discussed in the analysis of the characteristics of child trafficking: surrogate terms, attributes, antecedents, and consequences. Knowing that the terms conceptual and empirical are not mutually exclusive in research, the large majority of the literature was composed of conceptual articles with few of an empirical framework. The few empirical studies in the sample consisted of both exploratory qualitative writings and one of the few quantitative reports on commercial sexual exploitation of children. While the goal of this concept analysis was not to display an equal representation of literature related to child trafficking as in a quantitative systematic review, the literature sample did consist of a variety of work related to the fields of law, public health, nursing, criminology, social work, and psychology. 29 Table 2.1 Concept Analysis Terms Used Term Surrogate terms Description Alternative words that communicate the very same meaning as child trafficking Attributes Items or characteristics that can be used to describe key elements of child trafficking Antecedents Conditions and environment that leads to child trafficking Consequences Conditions and environment created as a result of child trafficking 30 Surrogate Terms Surrogate terms are those terms used in myriad ways to indicate the same concept of child trafficking but through different words and descriptors. Surrogate terms are different than related concepts, which may reference the concept but are not directly used with the same attributes (Rodgers, 2000). Surrogate terms used for child trafficking within the current data analysis included child slavery, domestic minor sex trafficking, and commercial sexual exploitation of children. These three terms were used interchangeably within the literature to express the same ideas and attributes assigned to child trafficking. While related concepts including child abuse, exploitation, smuggling, and child labor were used within the literature, their use occurred only in reference to child trafficking rather than as specific surrogate terms. Attributes While reviewing the literature, a common definition for child trafficking was not consistently used within the specified time period for the current data collection. Scholarly and practical work by a diverse group of authors representing many areas of domestic, foreign, and intercontinental discussions of child trafficking is the likely cause of inconsistent definitions. Additionally, the focus of these articles varied, producing distinct discussions related to the overall concept of child trafficking. For example, an article exploring the cultural components of child labor in countries in Africa may have a very different focus than an article deconstructing law related to the trafficking of children on a global stage of the United Nations. Common attributes among these diverse perspectives, however, were identified and will be expanded upon below. These attributes included (1) age, (2) vulnerability, (3) exploitation, and (4) violation of human rights 31 (Bergman, 2011; Chung, 2009; Estes & Weiner, 2001; Goździak 2008; Grace, Starck, Potenza, Kenney, & Sheetz, 2012; Howard, 2012; Kotrla, 2010; Logan & Hunt, 2009; Miko & Park, 2002; Smith, 2011). Age The concept of what defines being a child or youth is dependent upon the culture of the society in which they are living; what is considered coming of age in some cultures may be quite younger than that of other countries. On the international stage, however, the United Nations' established definition of child trafficking encompasses anyone under the age of 18 (United Nations Crime and Information Justice Network, 2000). Adding to the specific consequences encompassed by an individual of a child and teen age range were specific economic and sexual market demands for children rather than adults, resulting in recruitment strategies that played upon the child's lack of knowledge and access to external resources. As a result of these combined factors, the attribute of youth played an individual role as an attribute of child trafficking (Chung, 2009; Estes & Weiner, 2001; Fong & Cardoso, 2010; Goździak 2008; Grace et al., 2012; Jordan, Patel, & Rapp, 2013; Kotrla, 2010; Lalor, 2004; Logan & Hunt, 2009; Miko & Park, 2002). Vulnerability One of the most detailed features found within the concept of child trafficking was the basic distinction of vulnerability that victims of child trafficking possessed compared to an adult population (Howard, 2012). Missing among the trafficked child population were developed resources for basic survival (i.e., money, shelter, food), problem solving, maturity, and worldly knowledge present in that of a general adult 32 population. Instead, their dependency upon adults was noted. Descriptors of social immaturity, familial child abuse, running away behaviors, physical immaturity, parental drug use, and a still-developing psychological disposition may have originated as a result of the age of children and their familial background, but as a result of their existence in a trafficking environment created a highly visible vulnerability in the absence of adult support, adding to their susceptibility to exploitation and abuse (Bergman, 2011; Estes & Weiner, 2001; Fong & Cardoso, 2010; Goździak 2008, Howard, 2012; Lalor, 2004; Twill, Green, & Traylor, 2010). Exploitation At the center of the current data analysis were the driving factors, such as economic profit for traffickers, related to child trafficking and the key presence of exploitation. Oftentimes, the exploitation of youth derived from corrupt political or police systems that either directly or indirectly profit from the market demand of children, which was evident in cases of child sex tourism, rendering a largely profitable economic sector of the overall national economy in some countries (Smith, 2011). In addition, the culture of child sex trafficking often included a highly coercive and manipulative relational component present in the dynamics between children and their traffickers. This manipulation and coercion created a situation in which children felt emotionally tied and loyal to their pimps in the case of sex trafficking (Jordan, Patel, & Rapp, 2013). For children and their parents, hopes and dreams of a better future for the child were easily exploited by those looking to profit from the willingness and hard work of such families in finding an opportunity to better their life circumstances (Smith, 2011). The resulting 33 scenario was one in which children became separated from the protection of their parents, further increasing their vulnerability to exploitation in general. Violation of human rights Primary to the attributes describing child trafficking is a discussion surrounding the basic violation of human rights that occurs when a child is trafficked. In the literature and discussions of child trafficking are the ideas and references specific to children, such as the right to be protected from cruel acts and exploitation, the right to education, the right to be shielded from working conditions that hinder growth both physically and psychologically, and the right to be treated by the government or country as a child requiring special protections (United Nations Office of the High Commissioner for Human Rights, 2013). Furthering this discussion, descriptions and documentation were found that expanded on the existence of environments consisting of subordination, excessively long working hours, hazardous working environments, physical and sexual violence and abuse, imprisonment, the absence of medical care, abuse by multiple perpetrators, and threats of violence to self and others that directly violated the specific human rights of children (Chung, 2009; Estes & Weiner, 2001; Goździak 2008; Jordan, Patel, & Rapp, 2013; Logan & Hunt, 2009). Antecedents Antecedents are events or qualities that precede the existence of the concept (Rodgers, 2000). The current analysis of the child trafficking concept revealed the most commonly discussed dynamic present in creating an environment leading to child trafficking was poverty and the impact of globalization, whether that be specific to a 34 particular country or to global poverty. Contributing factors to poverty itself included the marginalization of women and people of color and the lack of power these populations exhibited in either earning income or their access to other forms of income. In many cases, this resulted in a desperate need to consider alternative situations for their children that might have provided for their most basic needs and a better life, such as domestic servitude, in exchange for educational opportunities (Fong & Berger Cardoso, 2010; Goździak 2008; Logan & Hunt, 2009; Miko & Park, 2002). In the case of globalization, the excess supply of children in need of income created an easily accessible economic market for the trafficking of child labor, domestic servitude, and the profiting from child sex acts, resulting in the environment necessary for such a supply of children (Estes & Weiner, 2001; Smith, 2011). Several articles discussed the existence of child trafficking as a result of the obvious demand of the child traffickers themselves, consisting of organized criminal groups, men's preference for sex with children, and businesses demanding cheap labor (Jordan, Patel, & Rapp, 2013). In addition, populations of child runaways exist in various domestic, regional, and intercontinental trafficking situations, adding to the unique attributes of the concept of child trafficking. Consequences Consequences in the evolutionary model of concept analysis entail the intended and unintended outcomes of the phenomenon being analyzed; in this case, the phenomenon is child trafficking. Among the human rights violations present in child trafficking, authors in this analysis discussed psychological, physical, and economic deprivations. Psychological effects included psychological trauma resulting in 35 posttraumatic stress disorder and the co-existing depression, anxiety, and substance abuse problems for victims, thus creating a need for ongoing mental health interventions (Fong & Berger Cardoso, 2010, Goździak 2008; Jordan, Patel, & Rapp, 2013). Present in the analysis was the role of healthcare providers in responding to the physical consequences of child trafficking, including sexually transmitted infections, unwanted abortions, and malnutrition (Fong & Berger Cardoso, 2010; Goldblatt, et al., 2012). Also present in this discussion of consequences were the diverse legal needs of children created as a result of their trafficking histories ranging from a need of protection by law enforcement, working legal definitions of child trafficking in societies where there were none, and the special legal representation of children to advocate for their rights in fighting the abuses and exploitation they have endured (Goździak, 2008). Absent within this analysis was a discussion on the macro- and mezzoconsequences of child trafficking. The primary focus of the authors centered on the specific human rights abuses and trauma imposed on the children rather than the potential economic gain made by traffickers and governments actively involved in the phenomenon. There are various reasons one can surmise as to why this is the case, such as a minimal discussion of specific countries responsible for globalization and government complicity in general within the child trafficking literature, the sensationalizing of child abuse and human rights violations, and a primary focus on micro-interventions rather than on macro- and mezzo-pull factors related to the existence of child trafficking. 36 Discussion The theoretical frameworks of Theory of Justice and Intersectionality are helpful in further examining and formulating a discussion on the results presented in this concept analysis. In the case of a Theory of Justice framework, inequalities and the responsibilities of the larger society to bring others at disadvantage to an equal playing field whether that be economic condition, ability, education, or societal placement are discussed (Lovett, 2011). The literature sample in this analysis emphasized the role of inequities as antecedents to child trafficking, such as poverty, gender, and race. Intersectionality provides a more comprehensive and in-depth look at inequalities and oppression from the multiple realities of the individual, or in this case, the experience of the individual being trafficked. Through this theoretical approach, the multiple oppressive categories affecting this population's human experience can be better understood (McCall, 2005). For example, the reality of a child of a minority, disabled, or impoverished economic status and their experiences of oppression among those social inequities helps to provide us with a deeper understanding of the nature of reality (McCall, 2005). Based upon the literature sample, this analysis provides a glimpse into the concepts associated with child trafficking directly impacting this population's lived experience such as poverty, age, gender, and their connection to human rights violations, physical and psychological abuses, and exploitation. A majority of works in this analysis focused on child trafficking and equated trafficking to the sex trafficking of children while neglecting other forms of child trafficking including hard labor, domestic servitude, or debt bondage (Chung, 2009; Fong & Berger Cardoso, 2010; Goldblatt et al., 2012; Jordan, Patel, & Rapp, 2013; Kotrla, 37 2010; Smith, 2011). While the sex trafficking of children is indeed a form of child trafficking, it is but one among several others; however, it received significantly more attention within this particular literature search. Whether this is the result of the particular databases or search terms that were chosen for this analysis is unknown but should be noted for future concept development in this area. Much of the data discussed child trafficking in its various forms by focusing on the use of definitions in guiding the use of law in prosecuting trafficking acts or in combating the trafficking of children through the further development of law in the respective country being represented in the article (Bergman, 2011; Chung, 2009; Fong & Cardoso, 2010; Kotrla, 2010; Lalor, 2004; Marcus, Riggs, Horning, Rivera, Curtis, & Thompson, 2012; Miko & Park, 2002; Smith, 2011). In addition, works commonly reviewed the implementation, hazards or benefits, or particular legal frameworks and how legal tools are utilized. Law requires very specific operationalized definitions of child trafficking, and based upon legal history, commonly referenced the key phrases of "use of threat, force, fraud or coercion and deception" as set forth in the definition of child trafficking by the United Nations, International Organization of Migration, and the International Labor Organization (Chung, 2009). Barriers to legal frameworks were also discussed, and they were particularly related to the role of child prostitution. Also common to the collected data was the description of trafficking on a spectrum of abuses or neglect originating from a variety of causes and resulting in a variety of both political, economic, and personal consequences. Most common to this literature was the reference to the detrimental effects of trafficking on the children themselves, resulting in both physical and psychological trauma such as the transmission 38 of HIV, malnutrition, depression, posttraumatic stress disorder, and substance abuse (Chung, 2009; Estes & Weiner, 2001; Fong & Cardoso, 2010; Goldblatt et al., 2012; Goździak 2008; Jordan, Patel, & Rapp, 2013; Lalor, 2004; Miko & Park, 2002). Such traumas were widely discussed and became the foci for much of the data. Theoretical Definition As a result of the current concept analysis, the following theoretical definition of child trafficking is presented: child trafficking is the specific exploitation of youth under the age of 18 years, initiated through force, fraud, coercion, and deception and characterized by the violation of human rights, including physical, sexual, and psychological abuse; the promotion of the phenomenon is motivated by economic gain in which individuals, social networks, and countries profit monetarily; the origin of child trafficking stems from a surplus supply of those individuals impacted by poverty, globalization, the marginalization of women and children, and individual circumstances attributed to the destabilization of family units, which generally increases the vulnerability of children. Limitations Based upon the specific nature of the current analysis involving the search terms chosen and the narrowing of a timeframe for the reviewed literature, there are inherent limitations to the results offered in this analysis. While other primary works within the field of child trafficking were also added, it is possible that additional writings were not included that could have added to the analysis and subsequent findings. The data 39 collected were only that of the English language, further limiting a potentially wider net of global information available to analyze. Summary This concept analysis was designed to further develop and define the concept of child trafficking through the use of Rodgers' (2000) evolutionary method of analysis. Through a discussion of surrogate terms, attributes, antecedents, and consequences, the current data analysis provides a holistic understanding of the uses, meanings, and actions associated with this concept. It is hoped that through this prescribed review of the literature, the concept of child trafficking will continue to be examined and used in the development of theory related to the causes, interventions designed to eradicate its occurrence, and efforts to minimize its impacts within a diverse range of fields. References Androff, D. (2010). The problem of contemporary slavery: An international human rights challenge for social work. International Social Work, 54(2), 209-222. Baldwin, M. (2008). Concept analysis as a method of inquiry. Nurse Researcher, 15(2), 49-58. Bergman, A. L. (2011). For their own good? Exploring legislative responses to the commercial sexual exploitation of children and the Illinois Safe Children Act. Vanderbilt Law Review, 65(5), 1361-1400. Botes, A. (2002) Concept analysis: Some limitations and possible solutions. Curationis, 25(3), 23-27. Chung, R. C-Y. (2009). Cultural perspectives on child trafficking, human rights & social justice: A model for psychologists. Counseling Psychology Quarterly, 22(1), 85- 96. Estes, R., & Weiner, N. (2001) The commercial sexual exploitation of children in the United States, Canada and Mexico. Philadelphia, PA: University of Pennsylvania School of Social Work. 40 Fong, R., & Berger Cardoso, J. (2010). Child human trafficking victims: Challenges for the child welfare system. Evaluation and Program Planning, 33, 311-316. Goldblatt Grace, L., Starck, M., Potenza, J., Kenney, P., & Sjeetz, A. (2012). Commercial sexual exploitation of children and the school nurse. The Journal of School Nursing, 28(6), 410-417. Goździak, E., & Collette, E. (2008). On challenges, dilemmas, and opportunities in studying trafficked children. Anthropological Quarterly, 81(4), 903-923. Howard, N. (2012). A critical appraisal of anti-child trafficking discourse and policy and Southern Benin. Childhood, 19, 554-568. International Labor Organization. (2002). Every child counts: New global estimates on child labour. Retrieved from ILO website: http://www.ilo.org/ipecinfo/product /viewProduct.do?productId=742 Jordan, J., Patel, B., & Rapp, L. (2013). Domestic minor sex trafficking: A social work perspective on misidentification, victims, buys, traffickers, treatment and reform of current practice. Journal of Human Behavior in the Social Environment, 23, 356-369. Lalor, K. (2004). Child sexual abuse in Tanzania and Kenya. Child Abuse & Neglect, 28, 833-844. Logan, T., & Hunt, G. (2009). Understanding human trafficking in the United States. Trauma, Violence, & Abuse, 10(1), 3-30. Lovett, F. (2011). Rawls's a theory of justice. New York, NY: Continuum International Publishing. Marcus, A., Riggs, R., Horning, A., Rivera, S., Curtis, R., & Thompson, E. (2012). Is child to adult as victim is to criminal? Social policy and street-based sex work in the USA. Sex Research and Social Policy, 9, 153-166. Miko, F., & Park, G. (2002). Trafficking in women and children: The U.S. and international response. Washington, DC: Congressional Research Service. Petri, L. (2010). Concept analysis of interdisciplinary collaboration. Nursing Forum, 45(2), 73-82. Rawls, J. (1993). The Law of Peoples. Critical Inquiry, 20(1), 36-68. Rodgers, B. L. (2000). Concept analysis: An evolutionary view. In B. L. Rodgers & K. A. Knafl (Eds.), Concept development in nursing: Foundations, techniques, and applications (pp. 77-102). Philadelphia, PA: Saunders. Schauer, E., & Wheaton, E. (2006). Sex trafficking into the United States: A literature review. Criminal Justice Review, 31(2), 146-169. 41 Smith, H. (2011). Sex trafficking: Trends, challenges, and the limitations of international law. Human Rights Review, 12, 271-286. Twill, S., Green, D., & Traylor, A. (2010). A descriptive study on sexually exploited children in residential treatment. Child & Youth Care Forum, 39, 187-199. United Nations Crime and Information Justice Network. (2000). Protocol to prevent, suppress, and punish trafficking in persons, especially women and children, supplementing the United Nations Convention Against Transnational Organized Crime. Retrieved from UNCIJN website: http://www.uncjin.org/Documents /Conventions/dcatoc/final_documents_2/convention_%20traff_eng.pdf United Nations Office of the High Commissioner for Human Rights. (2013). Convention on the rights of the child. Retrieved from http://www.ohchr.org/en /professionalinterest/pages/crc.aspx CHAPTER 3 WHAT THE HELPER KNOWS: VICTIM RESISTANCE AND THE EXPERIENCES OF SERVICE PROVIDERS WORKING WITH CHILD TRAFFICKING VICTIMS Introduction Although trafficking has been around probably since the very beginning of time, you know, we've exploited people forever, but there are very few concrete ways to deal with it and I think that and, you know, that troubles people. -Participant 2 While the existence of trafficking may have existed throughout time, efforts to prevent and end trafficking have begun within a relatively recent timeframe. What do we know about victims of child trafficking? What do we know about the responses aimed to aide victims? Why is it important? The goal of this study was to explore the experiences and observations of service providers working with victims of child trafficking in the United States (U.S.) with the intent of directly providing information to both practitioners and researchers alike who are charged with the development of service delivery models for this population. Vital to a discussion of child trafficking is a legal definition of what constitutes the trafficking and exploitation of children. This definition plays a pivotal role in the development and provision of services to this population (West, 2014). Therefore, in this 43 article, the definition of child trafficking is based on the Trafficking Victims Protection Act (TVPA) of 2000. Under the TVPA, the U.S. defines human trafficking as: 1. Sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or 2. The recruitment, harboring, transportation, provision or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. (United States Department of State, 2012) While an accepted federal definition of human trafficking in the U.S. exists, a common methodological formula allowing for concrete calculation of the magnitude of human trafficking does not yet exist. There are, however, annual estimated calculations disseminated by the U.S. in the Human Trafficking in Persons Report (Logan & Hunt, 2009; Tyldum, 2010). Likewise, there are alternative estimates on the prevalence of human trafficking produced by independent sources reporting a continuum of extremes based on relatively moderate to large numbers (Schauer & Wheaton, 2006; United States Department of Health and Human Services, 2009). For example, in 1999, the Central Intelligence Agency estimated that between 45,000 to 50,000 trafficking victims crossed U.S. borders every year, while each year, a different calculation was offered and steadily decreased to 14,500 to 17,500 in the 2004 Trafficking in Persons Report published by the U.S. Department of State. Yet, there are also nongovernmental sources that have estimated equally diverse estimates of individuals both crossing the U.S. border and currently living in the U.S. Estes and Weiner (2001) proposed that 17,000 children alone 44 are trafficked into the U.S. every year with an additional 100,000 victims from a domestic origin. It is also important to note that statistics have tended to focus on estimating calculations of foreign-born victims being trafficked into the U.S. while neglecting the issue of domestic victims born in the U.S. who are currently involved in human trafficking situations (Estes & Weiner, 2001; Goździak, 2005; Shared Hope International, 2014). It is estimated that the U.S. is the second most common destination country for human trafficking and that at least 40% of victims are estimated to be children (Estes & Weiner, 2001; Schauer & Wheaton, 2006). This information creates a need for interventions on multiple levels from a diverse range of disciplines such as law, medicine, and social work. Therefore, a professional understanding of child trafficking is needed to provide victims with the best possible outcomes among these various disciplines. This article provides an understanding of child trafficking through the lens of multidisciplinary service providers working directly with victims in hopes of communicating their diverse experiences and viewpoints. Among the research community focusing on child trafficking in the U.S., there has been a need to delineate between victims of foreign human trafficking and victims of domestic human trafficking based on different attributes fostering their involvement in trafficking as well as the specific aide and benefits that foreign-born victims are entitled to versus the lack of services for domestic victims. This study sought to specifically explore the experiences of all service providers regardless of their association with either foreign or domestic victims. This decision was made based on the limited number of research studies providing data focused on either population as well as the existence of 45 universal impacts of trafficking on the children themselves. These impacts span the spectrum of human needs regardless of domestic or foreign origins. Methods This study employed a qualitative, grounded theory research methodology to describe, understand, and theorize the experiences of individuals working in systems associated with providing services to victims of child trafficking. Service provision for victims of child trafficking in the U.S. is a topic that the current research hopes to understand from a constructivist approach. Within a grounded theoretical constructivist approach, "data do not provide a window on reality. Rather the ‘discovered' reality arises from the interactive process and its temporal, cultural and structural contexts" (Charmaz, 2010, p. 524). Concepts of grounded theory include the parallel process of data collection and analysis, the building of codes and categories, the making of comparisons at each point of the analysis, and the development of theory through each step of the process (Charmaz, 2010). The goal of this study was to explore provider experiences in hopes of informing social work policy and service provision to provide a more effective form of service delivery. Sample and Data Collection The target population of the research was defined as adult, working professionals who provide services (e.g., legal assistance, human services, advocacy) to victims and/or survivors of child trafficking. In 2013, a recruitment letter was sent to potential providers who were initially identified through previous professional contact with the researcher, which then resulted in referrals from those selected providers. Upon receiving a referral, 46 the researcher then inquired about the provider's interest in participating in the study with a compensation of $25 cash. Approval for the study was obtained by the University of Utah Institutional Review Board (IRB), prior to making contact with service providers. Following IRB approval, participants were sent recruitment letters and also received a telephone call if there was no initial response to the recruitment letter. Once contact was made with providers and they indicated interest in participating in the study, an interview time and location of the provider's preference was established. Thirteen interviews were held in-person as well as two over the telephone for those participants living in a variety of other states, which included Colorado, Arizona, Utah, and Indiana. A purposeful snowball sampling procedure was used, identifying two initial providers who specifically interacted with child trafficking victims and then recruiting new service providers for the study through the original interviewees' personal or professional relationships (Creswell, 2007). Procedures implemented included: • recruiting through provider referrals • recruiting with letters and follow-up phone-calls • receiving consent • conducting in-depth interviews with participants • completing a brief participant demographic survey, and • analyzing the interview data A total of 15 service providers from 12 separate agencies were interviewed through a semi-structured interview process (see Table 3.1 for interviewee demographics). An interview guide consisting of open-ended questions was used throughout each conversation with additional probe questions as the interview developed. Each interview 47 Table 3.1 Interviewee Demographics P Gender Ethnicity 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 M F F F F F F F F F M F F F F White White White White Multi White Latina White White White White White White White Multi Education Time in position Time in field Type of contact Yearly victim contacts Bachelors Masters Juris Doctorate Masters Bachelors Bachelors Bachelors Masters Bachelors Juris Doctorate Associates Bachelors Bachelors Masters Masters 1 2yrs 2yrs 7yrs 3yrs 6 mos. 1yr 8mos 3yrs 10+yrs 1.5yrs 2yrs 2yrs 2yrs 1yr 1 2yrs 2yrs 2.5yrs 4yrs 6mos 1yr 2.5yrs 3yrs 10+yrs 6yrs 2yrs 4yrs 2yrs 7yrs Foster care Case management Legal Residential Group home Outreach Outreach Advocacy Outreach Legal Police Case management Advocacy Outreach Foster care 10 6-28 10 Unsure 52 50 15-20 70 12-20 "Various" 30 2 25-50 10-15 30+ Note. P = participant 48 was audio recorded, lasted approximately 90 minutes and was then subsequently transcribed. Additionally, the interviewer wrote a series of memos prior to and following each interview including a reflexive process with special emphasis on the author's past experiences as a social work practitioner and beliefs related to providing direct services to youth (Charmaz, 2010; Jootun, Marland, & McGhee, 2009). Data collection ended when saturation was reached. Saturation can be described as the point at which, "the collection of new data does not shed further light on the issue under investigation" (Mason, 2010, p. 1). As Mason (2010) further explains, "qualitative samples must be large enough to assure that most or all of the perceptions that might be important are uncovered, but at the same time if the sample is too large data becomes repetitive and, eventually, superfluous" (p. 1). Saturation in this case was determined when categories were established, the differences between categories explained, and relationships observed and validated, allowing for a theory to materialize (Charmaz, 2010; O'Reilly & Parker, 2012). Analysis The analysis of the data collected through interviews with participants was conducted through initial open coding followed by axial coding. Open coding initiated initial descriptive codes while axial coding subsequently organized overarching codes that encompassed the categorization of the initial descriptive codes to shape an analytic framework (Charmaz, 2010). These coding activities were conducted through the use of Atlas.ti, a qualitative analytic data management program. 49 Reflexivity The author and investigator of the current research is a social worker who has focused on children, adolescents, and families in both child welfare and community mental health and emergency psychiatric settings for the past 14 years. The author's interest in child trafficking stems from personal clinical experiences with both domestic and foreign victims of child trafficking. Rigor and Trustworthiness The quality of the research is reflected in a variety of areas of the study. The trustworthiness and rigor of qualitative research minimize the presence of subjectivity by the researcher/s, which directly impacts the accurate depiction of the data (Barusch, Gringeri, & George, 2011). The credibility of the study was strengthened by data triangulation through the use of varied interview locations (Colorado, Arizona, Utah, Indiana), memos, and transcriptions: "The purpose of triangulation is to deepen understanding by collecting a variety of data on the same topic or problem with the aim of combining multiple views or perspectives and producing a stronger account rather than simply achieving consensus or corroboration" (Barusch, Gringeri, & George, 2011, p. 13). Thick description of participant interviews, as well as the engagement in the reflexive process on behalf of the author, addressed the confirmability of the data in an effort to solidify that the results are directly related to the data and separate from the researcher's own opinions and personal thoughts. 50 Results The interview data reconstructs participants' stories and voices into theory regarding their experiences and observations in the provision of services to victims of child trafficking from these interactive processes. The conversations and discussions with the service providers participating in this study frequently focused on concepts related to representations of barriers specific to this population. The most frequently discussed barrier was represented by the complex interplay of dynamics related to the resistance of children to interventions. While these interventions are designed to aid the child victim in leaving and recovering from their abusive and exploitive situations and are deemed necessary in responding to this social phenomenon, the interventions are nevertheless negatively viewed by many children. Ultimately, through an inductive qualitative process five themes were identified from the study, which will be discussed below. Good and Bad Victims I mean the thing is that obviously they are credible with me, because I understand. And I understand what they've gone through. But when you are looking at a jury of regular citizens that don't know anything about trafficking, they don't know anything about pimping or prostitution or anything, and they look at a 15-year-old girl that was out having sex with 5-10 guys a night and making all this money and using drugs, living in hotels, and drinking, um, and they are always going to ask the question, "Well, when you walked up to the hotel room couldn't you have just run away?" -Participant 8 The idea of children and teenagers resisting efforts to extract them from their exploitive situations challenges our ideal of children being compliantly innocent. The notion that they would willingly stay or return to the exploitive situation outside of the influence of fear can be confusing to some. This resistance on the part of victims is 51 especially difficult for the culture of the U.S. to understand in the case of the sex trafficking of children. Consider the following: Because she was pimped out since she was young, she was, "ugh, why should I do this? I know how to survive," meaning the pimping, right, the prostitution, and because she was so traumatized, she was just barely scratching the surface of working with it, but her time was almost up, and then you have to let them go, and well, guess what? They do what they know best, because that is what they live, which is the prostituting part then. Does that make sense? (Participant 11) In the case of labor trafficking, we make associations of children from a life of extreme poverty desperately trying to cling to the possibility of earning an income to survive despite the exploitive nature of their work. The general public may even view them as criminals themselves, perhaps as illegal immigrants committing a crime simply by being here, rather than focusing on concepts such as globalization and the underground market that a demand for cheap labor creates. However, in sex trafficking, we require victims to make efforts to "escape" their life of "sexual slavery." Ultimately, we require "good victims," those victims who were physically forced into a world of abuse, neglect, and servitude. Providers discuss the barriers encountered by the tension between good and bad victims: Um, for me, I saw a lot of struggle with the perception of good victim, bad victim, you know, so…. you know, like in sexual assault for example, the good victim is the completely conservatively dressed girl who walked home through a well-lit area and had a knife held to her throat and was sexually assaulted by a stranger. That's good victim, she didn't do anything wrong, she's an innocent darling. Bad victim which is what most sexual assaults look like… you were out with friends, maybe you had something to drink, you wore whatever you chose to wear, you are a person of color, you know what I mean? And so all those things work against you to paint you as somebody who was deserving. So, trafficking works the same way. (Participant 13) 52 Identification with the Trafficker I think it's easy for us to be like, why would you attach to this person, why do you still want to be with this person, why, even after all the things he or she has done to you, why do you still have this connection to them? -Participant 15 In sex trafficking, identification with the trafficker and the depth of the relationship that is developed between a victim and trafficker serves as a significant hindrance not only to agreeing to services but also to the successful utilization of those services. Some providers refer to this phenomenon as Stockholm Syndrome, which includes four descriptions: victims experienced a direct threat, they were kept in isolation at some time, they had an opportunity to escape but did not take it, and showed sympathy with their captors (Namnyak, Tufton, Toal, Worboys, & Sampson, 2007). Others describe this relational dynamic by using a metaphor for an interpersonal or domestic violence cycle in which many emotional needs of the victim are met at different points of the exploitation cycle. Providers explain that these various labels try to communicate a complex reaction to trauma and exploitation, preventing the victim from either self-identifying as any type of victim at all, or alternatively identifying with the new life and culture of the trafficker. The following description provides an example of the relational qualities involved in sex trafficking: If you are working with an incest victim, it's confusing for them to have been hurt by someone that is supposed to protect them, someone that is supposed to care for them, someone that they love and is part of them, and it's kind of the same dynamic, because they are set up as a family. You know, your typical sex trafficking, you would call your pimp "daddy," you would call the "top bitch," or the person that is kind of a "tough girl" in any particular type of ring, "mom," other girls that you are involved with, "sisters." You do things to support the ‘family'. You are not just selling yourself to support yourself, you are selling yourself to support the family. (Participant 4) 53 Understanding this unique relational element in the culture of sex trafficking is key to professionals not only in providing services but in designing services and program development that can address this specific dynamic to protect them from future abuse and facilitate a therapeutic recovery process. This bond continues to be discussed below: I think the big thing is they have to understand why they were victimized in the first place, so whatever led them to that, and they have to understand that coercive piece that goes into it. I mean there are so many that are, you know, in love with the trafficker, or they feel that they have some kind of bond with the trafficker, um, and so it's like I think professionals need to understand that. - Participant 9 This understanding of the victim's attachment to the trafficker and the preparedness of service providers to address this relationship is of vital importance in moving forward in the treatment process. Victim Self-Identification I don't know what category this falls into, but I think another kind of challenge always is just that, you know, I don't know that I've ever met a, like a child or an adult client who has said like, "I am a victim of human trafficking." You know? -Participant 2 Identifying one's self as a victim requires understanding of a variety of concepts on multiple levels. An individual must believe they are being hurt and mistreated by others, they must have a nonabusive reference point to compare their now normalized treatment to, they must understand that what they are experiencing is wrong, and they must understand that they have a right to a life without abuse. Seriously compromising these significant and monumental understandings is the fact that the victims are children. These are children and teenagers who service providers describe as traumatized; they are emotionally bonded to their perpetrators and have normalized a life of exploitation: 54 And the problem is that you take them out of a situation that is horrible, but then you now have to explain to them why it was horrible... it's like in an incest situation, that someone that you cared about is ultimately responsible for exploiting and hurting you, and then you have to acknowledge that you allowed yourself to be, you know, manipulated and lied to and believed that and to believe that you sold yourself and you allowed yourself to be sold. (Participant 15) Self-identification as a victim of any type of abuse, let alone an exploitive and systemically enforced process of abuse is described by providers as a significantly difficult process. Service providers describe the complicated nature of this issue as mirroring a protective and complex system of denial that must eventually be overcome if safety and healing is to occur: I think with every single girl that I've ever worked with is that they don't realize they are victims. If they are involved in an abusive relationship or if you were abused as a child, um, I think it's, even though there is some denial there, in most situations, it's very easy for you to connect with a little bit of education that you were a victim. But the girls that I work with… it's hard to admit that you allowed yourself to be extorted in such an intimate way. And so most girls don't realize that they were trafficked, they don't understand that language, they don't understand that they have a right to be called a victim… and so I think that complicates the restoration process. Because most people are outside looking in, seeing you are in a bad situation, and if I take you out of that bad situation, then you are going to be grateful and you are immediately going to respond to treatment and you are going to immediately want to heal. (Participant 15) In another instance, a service provider again describes the trauma bond with the trafficker and the outcome as a result: I mean obviously you have the mental barriers on their own because of the trauma bond that they form with the pimp or the trafficker, and so a lot of them, they don't feel like victims, and they feel like they were willing participants who wanted to do it, and they don't see the coercion in everything. (Participant 4) Building Trust with Providers Providers describe the trust-building process with children and teens as imperative to their work. 55 Oh yea, if you have a relationship with a youth and there is no trust, there is no trust-building capacity or "rapport" that we all know about, that we hear about so often…if that isn't built, you can squash the whole thing; it's over. (Participant 13) If victims are to acknowledge the depth of their abuse and exploitation, there must be adequate supports and relationships in place to provide emotional safety and containment. This relationship must overcome the doubt and uncertainty experienced by victims as they are extracted from their former relationships and requires that providers be attuned to this dynamic. Trust for teenagers who have a significantly increased ability to run away or to decline service interventions in general is described as a first step in the development of any type of help and assistance: You cannot just go in and say. "oh, this has happened to you and it was wrong, and now we are gonna fix this." That is not how it works. There is nothing that is going to happen, and, in fact, you can actually push that teen farther out of the light and more underground because they are too afraid of...they haven't built the trust. So, they'll probably, they have a tendency to hide from service providers or hide from law enforcement or get themselves in places where they are more vulnerable underground. (Participant 8) Throughout the interviews, victims were described as, "wary," "doubtful," and "uncertain" when either voluntarily entering into services or mandated to receive services. As a result, building trust with victims was described as both essential and time consuming, requiring the financial resources that can withstand this extended period, which are often limited due to a shortage of funding in human services programming. You have to establish the trust, you have to accept them, not judge them, and walk with them at their pace, and we can't do that at this point, because it costs too much money. We do not have the resources for that, and it takes a long time. (Participant 8) 56 This trust process is further extended by the hesitancy of child victims to recount their stories in addition to the internalized and societally reinforced shame that many victims experience. One provider explains that this feeling of shame can create a self-imposed cloak of victim invisibility: And, um, I think it's just the way society looks at them as being homeless, a prostitute, a drug addict. It's just not worth their time, and the kids know that, how society looks at them. One of them said she feels she is invisible, that's what she said. Invisible to society, just because she is homeless, she has to prostitute herself, and a lot of them are addicted to drugs, to deal with the life, and I think that is probably the biggest hurt for those kids, you know, they are invisible to society. (Participant 14) In order to qualify for and receive services, it is often required that a victim's circumstances and experiences be documented, requiring that victims recount their story numerous times to different providers. This requirement is described as a barrier, only serving to interfere with the genuine connection and trust built. One provider recounts the inability of victims to continue this process: And I always tell kids, too, "you don't have to tell everyone your story, it's not anyone's business what your story is. You don't have to feel like you blab it out because as a young child you've learned, I've had this therapist, that therapist, this treatment center, this psychiatrist, this caseworker, this GAL, I always tell them my story. You don't have to tell everyone your story. It doesn't define who you are." (Participant 8) Building trust is impacted by many factors for victims as the participants have already discussed. If these barriers are not able to be addressed effectively, victims may present as noncompliant in treatment or refuse services altogether, resulting in what appears to be victim resistance. 57 Lack of Empowerment The empowerment, or the fostering of self-determination, of children is a complex topic. Empowerment in and of itself is described by providers as an ideal component in intervention efforts as well as vital to a healing process for an already disempowered population: You want to get in there and rescue and you know that rescue doesn't work, um, this is about empowering someone to advocate for themselves, self-determination, all those fun things we learn in college and in textbooks. It is real. It is so real. (Participant 2) What complicates this appealing exemplar rests in the cultural and social norms of the U.S. surrounding an acceptable level of freedom and self-determination for children and teenagers, specifically those under the age of 18. This complexity increases in the cases of foreign-born victims who may have been raised in a culture where selfdetermination and adulthood may not follow the prescribed and magical 18-year age marker that exists in the U.S. and creates a sense of false adulthood in many victims. One provider explains this well, saying: If you think of like some of the things that kids have been involved in and like just kind of like the level of, like the savviness and sophistication it would take to be a successful drug mule or whatever, and you think of like, I don't know, you think about doing that and like, you know, I don't know, flying in and out of like airports and having like travel arrangements. Because, you know, sometimes, it's almost like somebody had this job for an international organization, and granted, it was like a really crappy job and stuff, but you think of going from that to again like, now I live in a suburb with a family that you know tells me what time to go to bed. (Participant 2) The cultural contrast and expectation of independence and freedom continues in the description below as victims of labor trafficking may have anticipated a life of promise in the U.S. in contrast with the actual interventions put in place that deter them from an independent adult-like life. 58 I wonder what that's like to think like, oh I'm going to, you know, I'm going to be a housekeeper and I'm going to have my own income and I'm going to go to school and then maybe eventually I'll get my own place, to like, oh, I've got a foster mom, you know? (Participant 2) Not unlike foreign-born victims, U.S. teenagers treated as adults with adult expectations and adult access to money, substances, and life experiences, however negative they may be, may resist what they perceive to be a revocation of their freedoms and independence: It is demeaning. I mean here's somebody who has already been in an exploitative situation where somebody else has been speaking for them… so you are away from your trafficker and now you are with your caseworker, you know, so, um, yea, so now somebody else is telling you what to do. (Participant 13) Due to this perceived punitive relationship and lack of empowerment, several providers voiced the need for alternative approaches for this specialized population. The involvement of child welfare and mandated services further complicates the role of empowerment, as life-changing decisions must be made. These interventions may include higher levels of care, such as residential treatment, for teenagers who cannot be safely engaged in treatment through lower levels of care in the community such as foster care and group homes. Providers describe some of these concerning risk factors as running away, substance abuse, complex trauma, and generally illegal activities. Providers elaborated on the need for specific secured program settings for the child trafficking population rather than historic residential programming because of victims' previous experiences of exploitation and the resulting disempowerment as a result. Consider these thoughts from a service provider: You know, they need to be able to think on their own, not always have people tell them when you're going to eat, what time you are getting up. They need to learn how to put structure in their own life, but I think there is a little bit better way to do it than historical residential treatment centers. (Participant 4) 59 For foreign-born victims involved in the child welfare system, the disconnect of well-meaning protective interventions can further disenfranchise children as a result of the systemic and mandated interventions themselves as described below: I mean especially if they are in federal foster care, they have those case workers, they might have a county case worker, they have a guardian ad litem, you know, especially if it's like, you know a teenage girl with a baby then the baby has a guardian ad litem, so like we end up going to these meetings where it's, you know, like, maybe me and one of the immigration attorneys and then like 13 other, usually, social workers, white women, in the room, and we're all talking about this brown child, and just like what the hell is going on? (Participant 2) While well-meaning, services that are designed to protect, whether they be at a federal or local level, also present the risk of further alienation and a misunderstanding of the victim's needs if providers are not aware of the potential impact they have. "I just think that like the potential for like, you know, continued oppression is pretty great if we are not conscientious about it" (Participant 9). Discussion Several constructs related to the theme of victim resistance and the avoidance or refusal of provider interventions have been presented in this article that will now be discussed in further detail. This discussion will expand on each of the themes presented earlier in an effort to further understand the experiences and observations of service providers. This study describes several complex aspects contributing to the overall resistance of child victims of human trafficking in accessing services to interventions such as mental health, basic needs, legal assistance, housing, and substance abuse treatment. While the current estimates on the magnitude of this population vary significantly due to the underground nature of the trafficking phenomenon, it has been established by these service providers that there are significant needs for interventions 60 and services that do indeed exist. However, the avenues in accessing these services vary, as does the willingness of youth in utilizing them, especially in specific cases of older children and teenagers involved in both labor and sex trafficking as discussed earlier by service providers. The data regarding this overall resistance provide researchers and providers alike with information and insight into specific aspects of this resistance, as demonstrated in Figure 3.1. The theoretical framework of Intersectionality provides a more comprehensive and in-depth look at oppression from the multiple realities of the individual, or in this case, the experience of the victim of child trafficking. Through this theoretical approach, the multiple oppressive categories affecting this population's human experience can be better understood (McCall, 2005). For example, the reality of a child victim of a minority, disabled, or impoverished economic status and their experiences of oppression among those social inequities helps to provide us with a deeper understanding of the nature of reality (McCall, 2005). Based upon the current research, the core concepts associated with victim resistance such as psychological trauma, social judgment through the criminalization of children participating in commercial sex acts, and marginalized family backgrounds aid us in understanding the lived experiences of the child trafficking victim. Victim Resistance I mean, a lot of the stats say that if you work with human trafficking clients, even with teenagers, right, they go back like a domestic violence cycle. It takes them about 5-7 times to leave this life. We are not prepared for that. -Participant 9 There is an understanding within the larger human trafficking community of providers and activists working to address trafficking that identifying victims is in part 61 Figure 3.1. Attributes of victim resistance 62 hindered by the fear victims experience related to coming forward for help (Bales & Soodalter, 2009). These reasons may be related to a fear of violence, threats to family, lack of documentation, and punishment by police (Bales & Soodalter, 2009). However, other psychologically-oriented processes exist, creating challenges for providers that require attention in the provision of appropriate services in co-existence with the resistance of victims. The challenges that arise include the struggle of good vs. bad victim, identification with the trafficker, victim self-identification, the ability to build trust with providers, and lack of victim empowerment, which will now be discussed. Good vs. Bad Victim Throughout this study, service provider discussions of social and cultural views of victims and their worthiness as a "good victim" play a key role in determining the reactions and interest of victims to the interventions set in motion by service providers. Service providers described a "good victim" as a victim with whom society sympathizes: for example, a child from an upstanding family with a life of privilege who is abducted by a stranger. A "bad victim" may come from a less than desirable family background or may have origins in a marginalized population. This victim may have believed he/she was consenting to serve as a drug mule or that he/she was helping the trafficker. It is more difficult for society to sympathize with a "bad victim"; ultimately, a gray world exists, creating social views of "bad victims" that are more difficult to interpret within traditional black and white parameters. In states like Colorado, where there are currently no Safe Harbor laws that solely identify youth as victims of sexual exploitation rather than criminals, and child prostitution laws still exist, the role of law enforcement and the process of criminalizing 63 victims of commercial sex trafficking send a powerful message to victims indicating/implying they are criminals in the minds of the state or other authority figures. It is generally understood in U.S. culture that criminals are either removed from society and/or punished for their crimes. While Colorado-based service providers in this study described the use of this legal process as a means of protection and actually funneling victims into mandated services for their own benefit, providers also indicated their preference to eradicate the message that such laws send to victims and the general public regarding the free agency of children to willingly prostitute themselves and enter into other exploitive situations. In this case, shame, as a result of fulfilling the role of "bad victim," serves to deincentivize victims in general, thus leading to avoidance of situations requiring victims' personal histories, experiences, and relationships with traffickers to be judged by others. Qualifying for services requires being identified as a victim, oftentimes recounting one's story multiple times and opening one's self to the scrutiny and judgment of others. The fear of social rejection naturally follows, further entrenching victims into a spiral of avoidance and, ultimately, resistance to interventions. Lack of Empowerment As described by service providers working in the field, perceived oppression, restrictive environments, and mandated services contribute to a lack of victim empowerment. As discussed earlier in this article, children in exploitive and abusive situations are often put into adult-level scenarios and are forced to make choices and endure situations most adults will never have to face, all while filtering these experiences through the age-appropriate developmental level. These scenarios may involve the use of 64 drugs and alcohol, the absence of structure and predictability common to children's routines, or a performance expectation and accompanying responsibilities associated with individuals of a much older age, such as earning income to support their trafficker. There are a myriad of situations and experiences to which a child in a trafficking environment may have been exposed and to which he/she acculturated over a period of time. These experiences later amplify the jarring return to childhood normalcy once services are reintroduced into the life of a trafficked child. Service providers in this study described the difficulties children encountered once required to adhere to routine, tedious environmental requirements, and behavioral expectations. The use of higher levels of care, such as residential treatment and other restrictive environments, provides clear examples of the reduction in freedom and stark contrast to the choices a child may have had while being treated as an individual who was well beyond his/her years. The monitoring of the child's activities, use of security measures to control communication and physical whereabouts, along with their required presence in daily treatment activities, may be perceived by some children as punishing and oppressive even though the express purpose is protective and rehabilitative. Ultimately, the safeguards created in service provision are described by service providers as contributing to non-compliance or outright refusal to participate in services altogether, further reinforcing the theme of resistance. Overcoming this perceived oppression amongst a population defined by oppression is discussed frequently by providers in this study who outline the necessary steps taken in order to help children recover from their traumatic and life-altering experiences. 65 Building Trust with Providers Difficulty trusting others after experiencing abuse and exploitation is not difficult for most to understand. However, when trusting those people directly responsible for your care, treatment, or basic needs (i.e., service providers) is perceived as threatening, the need to rectify that difficulty becomes imperative to those providing interventions. Service providers in this study shared in detail the variety of measures taken while attempting to establish trust with child victims, many times with negative outcomes. Most commonly discussed was the need for time to develop a shared history with the child. Unfortunately, providers described the inability to take the time to slowly engage a child due to lack of sufficient funding that would allow for a longer process. Additionally, a lack of the necessary financial and structural tools to address the immediacy of the safety needs presenting themselves was presented within different scenarios presented by providers. Many providers did not believe they were equipped to successfully navigate the complexities of a victim's broken trust system due to the victim's internalized shame as a result of social judgment and the general doubt of others. Identification with the Trafficker Victims of the child trafficking experience are exposed to numerous physically and psychologically traumatic events and situations. There are times when victims will appear to have formed a positive relationship with their trafficker despite the abuse and coercion they have experienced. Beginning in the 1970s, the term historically referred to in the media and popular culture as Stockholm Syndrome describes a positive relational bond with the perpetrator consisting of several situational characteristics: (1) there is a perceived threat and belief that the threat will be carried out; (2) the victim perceives 66 kindness from the perpetrator; (3) the victim is deprived of outside views other than those of the perpetrator; and (4) the victim believes there is no escape (Adjoran, Christensen, Kelly & Pawluch, 2012; Namnyak et al., 2007). Terms such as Stockholm Syndrome and trauma bonding are used in the literature pertaining to the psychological trauma experienced by victims to explain this identification with the perpetrator (Adorjan et al., 2012; Cohen, Mannarino & Deblinger, 2006). However, more recently, research has focused on the concept of complex trauma, which was first proposed by Herman (1992) and can be summarized as, "symptom clusters reflecting alterations in affect regulation, consciousness, self-perception, perception of the perpetrator, relations with others, and systems of meaning" (Ai, Foster, Pecora, Delaney, & Rodriguez, 2013; Resick et al., 2012, p.241). The descriptions of these interchangeable concepts presented by Herman (1992) will aid the reader in understanding the dynamics described in this article, which consist of identification with the trafficker, perceived lack of empowerment, trust of providers, identification as a good or bad victim, and identification as a victim of child trafficking in general. Service providers in this study frequently discussed, in detail, specific instances and examples of children who had endured severe sexual abuse, physical abuse, and psychological abuse yet remained emotionally connected and protective of their trafficker. Not unlike a child who experienced trauma at the hands of a parent, there remained a dependence on the trafficker, an altered meaning of multiple realities, and the potential adoption of the parent's worldview in relation to the abuse. Service providers in the study discussed the extreme lengths that victims of child trafficking would go to in order to maintain emotional and physical contact with their traffickers. These extremes 67 included, but were not limited to, internet contact, phone contact, letters, running away, and sending messages through peers. Providers described these attempts as originating from an emotional desperation to maintain a relationship that many victims perceived as validating, loving, and protective. Providers often described the painstaking and delicate process of "breaking the bond" with the trafficker as the primary treatment goal to meet if emotional and physical safety were to be achieved by the victim. How to go about breaking that bond was not as clear or straightforward; some providers stated this process could take months or years and that the approach would likely vary across treatment instances. Lack of Self-Identification As an adult individual living outside a world of trafficking and its many intricacies and hidden qualities, it may appear to be easy to overgeneralize and therefore label acts that are abusive and exploitive as human trafficking. Service providers, however, described an alternate reality not only for children but for adults as well. In particular, child victims do not have an adult framework for defining abuse and exploitation and rarely understand the labels placed upon their experiences. The absence of a comparative framework creates a confused sense of reality for the child victims. Therefore, they most often do not identify themselves as a victim. Providers in this study consistently described their difficult experiences of teaching victims about the dynamics of trafficking and what constitutes abuse as well as exploitation. They discussed the lack of normalcy in a victim's life and a void of alternate realities as reference points to guide this educational process. 68 Limitations While I attempted to design the current study with rigor and trustworthiness in mind, limitations nevertheless exist and should be taken into account. The first of these limitations is the minimal discussion of labor trafficking with an overemphasis on sex trafficking. Closely related to this limitation is the focus on domestic victims with only a few examples of trafficking of foreign child victims. Another limitation relates to the potential for a subjective interpretation of the data that were collected. I was the only researcher coding the data, thus limiting external points of view. Finally, I spent a total of 7 months collecting data, which limited the amount of prolonged exposure to the experiences and culture of service providers working with child trafficking victims. Conclusion This study described the experiences and observations of service providers working with child victims of human trafficking with an overarching theme of victim resistance. This theme is difficult to understand at face value; however, I hope that through an understanding of the observations of providers, the reader will gain insights into the experiences and potential resistance to interventions of child trafficking victims. Without a direct and comprehensive discussion of resistance, we are not prepared to offer these children the best possible treatment outcomes, which they clearly deserve and should expect from the adult caregivers in their lives. Additionally, it is hoped that the discussion of victim resistance included in this article provides both social work practitioners, as well as those in a position to effect policy, information that is necessary in developing and providing the direct services needed by this population. Through the examination of victim resistance in the realm of 69 research and policy, social workers can more effectively meet the unique needs of victims of child trafficking. References Adorjan, M., Christensen, T., Kelly, B., & Pawluch, D (2012). Stockholm syndrome as vernacular resource. The Sociological Quarterly, 53, 454-474. Ai, A., Foster, L., Pecora, P., Delaney, N., & Rodriguez, W. (2013). Reshaping child welfare's response to trauma: Assessment, evidence-based intervention, and new research perspectives. Research on Social Work Practice, 23(6), 651-668. Bales, K., & Soodalter, R. (2009). The slave next door: Human trafficking and slavery in America today. Los Angeles, CA: University of California Press. Barusch, A., Gringeri, C., & George, M. (2011). Rigor in qualitative social work research: A review of strategies used in published research. Social Work Research, 35(1), 11-19. Charmaz, K. (2010). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage. Cohen, J., Mannarino, A., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York, NY: Guilford Press. Creswell, J. (2007). Qualitative inquiry and research design: Choosing among five approaches. Thousand Oaks, CA: Sage. Estes, R., & Weiner, N. (2001). The commercial sexual exploitation of children in the United States, Canada and Mexico. Philadelphia, PA: University of Pennsylvania School of Social Work. Ferguson, K., Soydan, H., Lee, S., Yamanaka, A., Freer, A., & Xie, B. (2009). Evaluation of the CSEC Community Intervention Project in five U.S. cities. Evaluation Review, 33(6), 568-597. Goździak, E. (2008). On challenges, dilemmas, and opportunities in studying trafficked children. Anthropological Quarterly, 81(4), 903-923. Goździak, E., & Collett, E. (2005). Research on human trafficking in North America: A review of literature. International Migration, 43(1/2), 99-128. Herman, J. (1992). Trauma and recovery: The aftermath of violence-from domestic abuse to political terror. New York, NY: Basic Books. Jootun, D., Marland, G. R., & McGhee, G. (2009). Promoting rigour in qualitative research. Nursing Standard, 23(23), 42-46. 70 Logan, T., & Hunt, G. (2009). Understanding human trafficking in the United States. Trauma, Violence, & Abuse, 10(1), 3-30. Lovett, F. (2011). Rawls's a theory of justice. New York, NY: Continuum International. Namnyak, M. Tufton, N., Toal, M., Worboys, S., & Sampson, E. L. (2007). "Stockholm syndrome": Psychiatric diagnosis or urban myth? Acta Psychiatrica Scandinavica, 117, 4-11. Rawls, J. (1993). The law of peoples. Critical Inquiry, 20(1), 36-68. Resick, P., Bovin, M., Calloway, A., Dick, A., King, M., Mitchell, K., Suvak, M., . . . Wolf, E. (2012). A critical evaluation of the complex PTSD literature: Implications for DSM-5. Journal of Traumatic Stress, 25, 241-251. Schauer, E., & Wheaton, E. (2006). Sex trafficking into the United States: A literature review. Criminal Justice Review, 31(2), 146-169. Shared Hope International. (2014). FAQs. Retrieved from https:/www.http://sharedhope .org/learn/faqs/ Tyldum, G. (2010). Limitations in research on human trafficking. International Migration, 48(5), 1-13. U.S. Department of State. (2012). Trafficking in persons report. Washington DC: Author. West, A. (2014). Child trafficking: A concept analysis. Unpublished manuscript. CHAPTER 4 THE CHILD WELFARE RESPONSE TO CHILD TRAFFICKING: VIEWPOINTS OF SERVICE PROVIDERS WORKING WITH CHILD TRAFFICKING VICTIMS Introduction The goal of this study was to gain a deeper understanding of the observations, experiences, and opinions of service providers working with victims of child trafficking in the United States. An overarching theme discussed within the interviews conducted with 15 services providers for this study was that of the response and involvement of the child welfare system. This article will expand on the discussions that took place throughout the study in an effort to create a dialogue surrounding the specific needs of this youth population. Background The trafficking of children for sex and labor is one of the fastest growing industries occurring in the United States. It will eventually surpass drug trafficking in its breadth and profit (Miko & Park, 2002; Schauer & Wheaton, 2006). Children are trafficked into the United States from their countries of origin and children who already reside in the United States are trafficked domestically. The trafficking of children is not 72 new and has, in fact, existed as long as slavery and exploitation itself through physical and psychological abuse, manipulation, and threats. Present-day awareness of this modern, underground phenomenon, however, is relatively new and increasing. Through the efforts of nonprofit organizations, public awareness campaigns, and local community discussions, the conversation on child trafficking has grown at the federal, state, and local levels. To lend an understanding of the scope and extensive nature of human trafficking of adults and children alike, one must understand the enormity of income generated by traffickers and organized crime networks, which is estimated to be between $U.S.32 and $U.S.91 billion each year (Kotrla, 2010). Calculating the magnitude of child trafficking is quite difficult due to its underground and criminal nature, as well as the reluctance of victims to come forward due to fear of violence and retaliation by traffickers (Goździak & MacDonnell, 2007). Likewise, research in this area also encounters severe limitations because of this underground element (Goździak, 2008; Tyldum, 2010). Estimates of the occurrence of child trafficking range from conservative reports of 17,000 children under the age of 18 being trafficked into the United States each year to larger reports of 100,000 children being trafficked domestically within the United States every year, with still another 244,000 children at-risk of being trafficked annually (Clawson, Dutch, Solomon, & Grace, 2009; Estes & Weiner, 2001; Smith, Healy Vardaman, & Snow, 2009). The majority of victims of this crime are estimated to be women and children; 70% of women enter a trafficking situation prior to the age of 18, and the average age of entrance for a trafficked child ranges from 11 to 14 years (Goździak & MacDonnell, 2007; Kotrla, 2010; Miko & Park, 2002). 73 In the United States, multiple policies and legal frameworks exist that dictate how and when the child welfare system should intervene when the abuse or neglect of a child is suspected or confirmed. These frameworks are present at federal and state levels alike, creating a cumbersome landscape for child welfare entities to navigate with current federal policy emphasizing keeping children safe and connected to families, promoting the well-being of children in child welfare services, and improving the delivery of critical services (Casey Initiative, 2013). Furthermore, funding avenues associated with child welfare are complex, deriving from each of the federal, state, and local levels. On a federal-level exists Title IV-E of the Social Security Act as a major funding source, an established and uncapped funding stream with the primary focus of funding foster care placements (Courtney, Flynn & Beaupre, 2013). The Title IV-E program requires a percentage of matching state funds in order for the state to fully access the maximum benefits of the program. In 2010, $29.4 billion dollars were spent on federal (43%), state (45%), and local (12%) levels with the majority of dollars used to fund foster care (Courtney et al., 2013). Congress has refused to allow flexible use of the funds for the Title IV-E program even in the case of supporting evidence-based practices for children in foster care. The only exception to this has come in a program waiver that was granted to five states in an attempt to examine how the funds might be able to finance alternative practices separate from foster care. Ironically, Title IV-E funds are currently prohibited from being used flexibly for activities such as child abuse prevention or post-reunification services (Casey Family Programs, 2010). According to a report published by the Casey Family Programs (2010), $6 billion dollars was disbursed to states in 2006 for the primary financial goal of 74 funding foster care placements. In contrast, $1.6 billion dollars was made available to states through capped block grants on prevention and early intervention, including inhome support services designed to prevent psychologically traumatizing out-of-home placements (Casey Family Programs, 2010). The role of this current discussion on funding serves to highlight the bureaucratic and legislative restraints that dictate how and when the child welfare system can financially intervene in abusive situations involving children. In the case of funding for victims of child trafficking, funding from state and county levels may not have the adequate flexibility needed in order to provide the specialized services that this vulnerable and unrecognized population requires. These services include, but are not limited to, higher levels of care (i.e., residential treatment that costs upwards of $75,000 per year per child or more), ongoing mental health treatment, focused interventions related to the family of origin (which is mentioned as a risk factor for child trafficking victims), and the ongoing assistance towards basic needs such as housing, employment, and medical care after a victim has left the child welfare system (Lyons, Libman-Mintzer, Kisiel, & Shalcross, 1998; Todres, 2012). Enter a new population: victims of child trafficking who have rarely been a focus of discussion or research due to the lack of awareness of their existence. Service providers in the study presented in this article discussed the role of child welfare in working with service providers as well as working with victims of child trafficking. The themes of these qualitative discussions are described in hopes of identifying ways in which both community service providers and the child welfare system can move forward as partners in their efforts to assist victims of child trafficking and understand how to 75 address the different needs of these individuals. This exploratory study presents information describing the inability of one system alone to address these needs. Methods As previously mentioned, the goal of this study was to explore provider experiences in working with victims of child trafficking. As such, a qualitative methodology was chosen in order to provide data that was rich in the description of personal experiences of service providers that would not be captured within a quantitative research design that emphasizes predetermined hypotheses. In this case, a qualitative design allows both service providers and the researcher to co-construct meanings, concepts, and descriptions. As an exploratory study, a grounded theoretical research methodology was utilized. Rather than entering the study with a set hypothesis, the theoretical foundation was developed concurrently with the data collection process, which is one of the primary concepts of Charmaz's (2010) grounded theory. Other key concepts of grounded theory include the collection of data and subsequent analysis in a parallel process, the building of codes and categories, and making of active comparisons at each point of the analysis (Charmaz, 2010). Sample and Data Collection The target population of this study was defined as adult (18-65 years of age), working professionals who provide services (e.g., legal assistance, human services, advocacy) to victims of child trafficking. After University of Utah Institutional Review Board approval was obtained for the study, service providers were recruited for 76 interviews at a location and time of their preference. All data collection activities were conducted in 2013. A recruitment letter was sent to potential providers inquiring about their interest in participating in the study with compensation of $25. Providers from Colorado, Arizona, Utah, and Indiana participated in the study through in-person and telephone interviews. A purposeful sample of 15 service providers who specifically interact with the child trafficking population (see Table 4.1) was interviewed through a semistructured interview process guided by predetermined, open-ended questions, followed by probing questions when necessary to fully understand the concepts at hand (Appendix A). Data collection ended when saturation was reached, and in this case was determined when categories were established, the differences between categories explained, and relationships observed and validated, allowing for a theory to materialize (Charmaz, 2010; O'Reilly & Parker, 2012). All data were analyzed through open and axial coding through the use of the qualitative analytic software, Atlas.ti. The study employed several qualitative methods to heighten the level of rigor and trustworthiness of the data collected, which included data triangulation, thick description, and reflexivity (Barusch, Gringeri & George, 2011; Creswell, 2007). Reflexivity Field notes consisting of memos were written by me to further describe the environment and experiences of service providers as well as to allow for a reflexive process that encompassed the author's worldviews and beliefs (Charmaz, 2010; Jootun, 2009). I am a social worker with over 15 years of direct practice experience in the areas of child welfare, community mental health, and emergency psychiatric settings. 77 Table 4.1 Service Provider Demographics Type of provider Education Yearly contacts Time in field Ethnicity 1. Police detective Associates 30 6 years White 2. Outreach worker Bachelors 12-20 3 years White 3. Therapist Masters Unsure 2.5 years White 4. Case manager Masters 6-28 2 years White 5. Attorney Juris Doctorate "Various" 10+ years White 6. Advocacy Masters 70 2.5 years White 7. Foster care Bachelors 10 1 year White 8. Case manager Bachelors 2 2 years White 9. Attorney Juris Doctorate 10 2 years White 10. Outreach worker Masters 10-15 2 years White 11. Group home Bachelors 52 4 years Multi 12. Outreach Bachelors 50 6 mos White 13. Advocacy Bachelors 25-50 4 years White 14. Outreach Bachelors 15-20 1 year Latina 15. Foster care Masters 7 30+ Multi 78 The reflexive process was of specific importance due to my experiences and beliefs surrounding these past practice experiences and their potential impact on the current research. Results One of the most frequently perceived concerns discussed in participant interviews centered on the involvement of the child welfare system. This concern was present whether from providers who were already working with victims directly involved with the child welfare system or from providers working with victims outside the "system" attempting to gain the involvement of child welfare for a variety of reasons, such as the funding of treatment. Among the concerns related to the involvement of child welfare services were the lack of identification of victims on the part of caseworkers, funding issues for providing victims with treatment and resources, and a lack of collaboration from the child welfare system. The following discussion more fully describes these concerns. Lack of awareness and victim identification Clearly, the identification of child trafficking victims is a difficult task as a result of several factors. First, many children do not identify themselves as victims of trafficking either due to established psychological bonds with their traffickers or a lack of awareness of trafficking and its associated traits of force, fraud, and coercion. They also do not identify themselves as victims due to fear of retaliation by their trafficker, fear of law enforcement, and fear of arrest and deportation (Jordan et al., 2013). Second, due to the lack of awareness by providers (i.e., law enforcement, child welfare, juvenile justice), 79 the situations of child victims are not recognized as trafficking, but are seen as delinquency, sexual assault, or physical assault by those outside of the home. Finally, public systems are unaware of the dynamics and traits involved in the trafficking situations of child victims, such as deception, exploitation, force, fraud, and coercion, and therefore do not further explore these attributes associated with trafficking situations. Instead of examining the potential for trafficking, it is not uncommon for a child welfare worker to view abuse by a third party abuse outside of his/her legal mandate to protect a child as they would if that child were the victim of a traditional abuse situation involving a parent or custodian (Fong & Berger Cardoso, 2010). This results in an absence of victim identification. A victim advocate involved in the research stated, And, if victim service providers like child welfare people are not educated about it, they don't know what to ask, they don't know what to look for, those kids get unrecognized, and they say it's a sexual assault but not really trafficking. Another provider (foster care) discussed her experiences with a lack of victim identification and the resulting outcome: Um, I would say one [barrier] is the caseworker identifying them as victims. I would say that's probably the biggest and first hurdle that a child has to get through. One, most of them [children] don't see themselves as a victim. Law enforcement generally doesn't see them as victims, prosecutors don't necessarily see them as victims, and the caseworkers don't necessarily see them as victims. So all those players have to get on board and identify them as victims needing specialized services before they can…before you can even talk about their homes, how good are those homes, and where would we send them? As an example, in the state of Colorado, where child welfare enforcement and jurisdiction is based within each individual county, the following residential therapy provider explained her experience with the knowledge and level of awareness by various county child welfare entities: 80 Education has to be first. They have to be open to admit that maybe they have missed something; out of the 64 counties that we have here in Colorado, one county is progressively seeking education about human trafficking with children, and. . . . the other counties, I don't know why they don't do it, but every county is run on its own with child welfare, so they call the shots, and if they say "oh no, we don't have that," they don't want to be educated about it, there is nothing you can do. And the kids fall through the cracks. The lack of involvement by child welfare systems was viewed by providers as a key obstacle in service provision, remaining a critical component required in order for children to be protected and cared for both physically and psychologically. These providers currently viewed child welfare systems as being separate from the primary provider movement to address the specialized needs of trafficked children, and they described wanting to increase the involvement of child welfare workers and systems in general. As one victim advocate noted, "They [welfare workers] are literally, they are such an important piece to that process, they really need to be educated and become part of the collaboration on what's happening." Embedded in the discussions held with participants was the sincere interest in a working partnership with child welfare caseworkers and helping to educate and increase the awareness of child trafficking within the child welfare system as a whole. Many times, service providers discussed the process of identification as a child trafficking victim as critical in gaining access to additional services for children to aid in their recovery. A provider serving as a case manager compared this identification process as a child trafficking victim as being similar to requiring a mental health diagnosis within the mental health system in order to receive funding for services: It's kind of like giving somebody a diagnosis, it can sometimes help open doors and whatnot… if we call you this, then you're eligible for that, or if you have this, then you can, you know, you can get on that program or whatnot. 81 Without this identification, the proper resources, treatment, and services for victims may remain out of reach (Jordan et al., 2013). Program funding Funding streams of any type within the field of human services are reported by providers as being competitively pursued and inadequate in many cases. Funding within the child welfare system is no exception to the struggle for adequate funding as discussed earlier. Adding mandates to care for a nontraditional population that has been abused outside of the home environment, such as victims of child trafficking, only adds to the budgetary constraints and struggles experienced by many child welfare systems regardless of federal, state, or county level (Courtney, Flynn & Beaupre, 2013; McLeod & Nelson, 2013). One law enforcement detective explained: I think most of the time, we work pretty well, and it's usually the conflicts over funding and money and, you know paying for residential treatment vs. paying for another thing. I think the biggest barrier to treatment though is who is going to pay? Nobody wants to pay. When you are talking about 49 kids, human services [child welfare] is like "Oh my God!" You know? Especially the kind of treatment they need, nobody wants to pay for that. Providers in this study often expressed their frustration with the funding structure and resulting inability to fund treatment for a significant period of time, or at all, as discussed below by a residential treatment therapist: Caseworkers say, "Get the kid out, get the kid out, I don't care if they miss school, I don't care, whatever, their education is not important, I want them home. We'll put wraparound services and everybody in the home, whatever we have to do, just get them out of that level of care." Providers also commonly viewed the lack of access to funding for victims as a result of child welfare entities guarding their financial resources and refusing to collaborate with treatment recommendations as a hindrance to the recovery of the child 82 victims with whom they worked. Service providers described caseworkers and the child welfare system as holding "the key" to opening doors for treatment that could not be accessed through any other system involved with the child trafficking population. The following description of this dynamic is explained below by a police detective: We have a problem in this state and most states where we can't just, so, if I contact a 14-year-old girl who came to a prostitution sting and then she tells me that she has a trafficker and stuff, I should just be able to say this is perfect, I am going to recommend through human services and they are going to place you in a good treatment facility, but the problem is it won't be funded. Human services is the only government agency that can fund that treatment. Lack of collaboration As previously discussed, multiple layers of rules, policies, and legislation on both federal and state levels exist that dictate how a child welfare system must respond to the abuse and neglect of children in the United States. So too exists a conflict and perceived lack of collaboration that service providers encountered in their interactions with the child welfare system as a result of the system's mandates: These girls come from all over the country and you will have child welfare saying "you know what, she's not from here." Well, yea, none of them are from anywhere, right? They are from all over. And so you have states going, "no she needs to go back to where she came from, and that is where she needs to be treated." Well, okay, so prove to me where she came from. In the example above, provided by a street outreach worker, the child welfare system in that state was unable to provide services because the child was not a resident of its catchment area as dictated by policy and legislation. However, to service providers involved, this was interpreted as an unwillingness to help and collaborate with them regarding provision of victim services. 83 Adding to this tension and perceived lack of collaboration between providers and child welfare, the system is also charged with reunifying children with their families, and reunification is the primary goal, if not sole mission, of this system based on both federal and state legislation. Placement outside of the home is only accessed when it is essential to the prevention of serious child maltreatment (Courtney et al., 2013). Based on this focus, the family of origin for victims of trafficking would be the first consideration for placement with alternative options of group homes or higher levels of care, such as residential treatment, only used as a last resort if the family of origin was unfit or incapable of caring for the victim. Providers in this study, however, frequently discussed the therapeutic need for higher levels of care outside of the home, such as residential treatment, in order to "break the bond" between victims and their traffickers in order to prevent future exploitation and trafficking. This decision is in opposition to the goal of family reunification. Victims of child trafficking often experience a multitude of abuses during their time with the trafficker, just as a child who was the victim of another form of ongoing and intimate abuse, such as incest. Due to the interpersonal dynamics present within a framework of complex trauma, they may view their trafficker as a protector, boyfriend, and as their primary source of both physical and emotional support (Herman, 1997). To address this trauma bond between victims and the trafficker, providers often referred to disagreements with child welfare over the recommended level of care as well as the length of stay within that level of care. A fair percentage of service providers in the study viewed the 24/7 secured setting of a residential treatment center as necessary to protect victims from the existing trauma bond and the resulting running-away behaviors that result. This 84 recommendation to forgo the initial reunification with the family of origin is a direct contradiction to the focus of child welfare, again creating the perceived lack of collaboration. The conflict with case workers over the most appropriate treatment setting, primarily over higher and more costly levels of care, only served to provide further tension between service providers and child welfare caseworkers who perceived themselves to be on opposite sides of the table. As a result, providers discussed having no voice and subsequent lack of input in working with child welfare caseworkers as described by the following group home administrator: They [child welfare] brought her to us, we took her on, we assigned a one-on-one person to her for a while with our survivor, myself, and you know the medical team working with her. We were able to get her to start wanting to live again, and that she really needs to value herself. So, she was able to do that. But the problem ended up being that you know, they turned around and took her from us before she was ready, and so she has run four more times from other shelters, and she has been drinking, on alcohol heavily, drugs... During the course of this study, many service providers pointed to severe dysfunction and a history of both physical and sexual abuse that originated within the family of origin, thus resulting in the child's involvement in trafficking situations in the first place. Mentioned within the literature on child trafficking, it is commonly believed that the dysfunction within the family of origin places the child at an increased risk of entering exploitive and abusive situations (Jordan, Patel & Rapp, 2013; Todres 2012). This family dysfunction may include previous neglect and abuse, substance abuse, and/or relational discord. The immediate reunification of these children to their families of origin would be contraindicated in this case. However, this issue can create both a legislative and ideological bind for the child welfare system that cannot be easily rectified. 85 Discussion In order to intervene with victims of trafficking and ultimately aide in their recovery process, identification is the obvious first step. Providers expressed both frustration and concern that child welfare workers were not familiar with child trafficking and/or not screening abuse and neglect reports for dynamics frequently associated with trafficking situations. Due to the reluctance of victims to come forward or even view themselves as victims, there was an increase in the need for child protection workers to not only recognize blatant trafficking situations but risk-factors as well (e.g., older boyfriends, isolation from others, substance abuse, mental health concerns, sexually transmitted infections, etc.). Providers in this study expressed concerns that child victims were either misidentified (i.e., categorized as sexual assault or physical abuse rather than having these events identified within an additional trafficking context when applicable) or were not identified as a victim of a crime or abuse at all. At the heart of the discussions related to child welfare involvement, service providers consistently presented frustrations related to accessing funds for services. The child welfare system was viewed as the gatekeeper to more intensive treatment as well as higher levels of care. Right or wrong, service providers did not perceive child welfare workers to have the best interests of victims in mind when creating hurried treatment plans focused on maintaining children in generalized foster care with the long-term goal of reunifying them with their family of origin. Service providers were skeptical of this traditional approach in working with youth and saw the trafficked population as requiring a much more comprehensive plan in order to prevent their future return to trafficking situations. 86 The disagreements related to treatment were followed by a natural progression of doubt related to their ability to work collaboratively with the child welfare system. Providers viewed themselves and child welfare workers to be on opposite sides of the table in relation to what services were appropriate for youth and how they should be provided. Significant differences in the philosophical views of addressing victim needs even went as far as to create what they perceived to be an adversarial relationship in most situations. Providers perceived child welfare workers as having the ultimate authority in making decisions related to treatment and levels of care that were motivated by pressures to save already limited funds. Due to this resource guarding, providers doubted that child welfare workers were interested in working collaboratively in general, especially given the differences in views on the most effective approach to treatment. The questioning of the child welfare system's motivations in protecting funding resources went as far as to believing that the child welfare system did not have an interest in becoming involved in protective concerns related to the child trafficking population in general. As a result, providers expressed wide-ranging doubt in bridging the barriers required in order to work in a collaborative manner. Figure 4.1 presents a visual depiction of the current involvement of the child welfare system related to child trafficking. These discussion points can be further interpreted through the use of a theoretical framework such as the Theory of Justice and its focus on the role of free and democratic peoples when discussing what Rawls' refers to as "burdened peoples" and honoring human rights. The Theory of Justice is based on the premise that the structure of a just society would be developed by agents who are motivated, open-minded, and rational, therefore, just and fair principles will result (Lovett, 2011). Through a just society, those 87 Figure 4.1. Current cycle of child welfare interaction with child trafficking population. 88 who are disadvantaged will be brought up to an equal level with those who are more advantaged on all levels, such as through social and economic means as well as the distribution of goods (Lovett, 2011). In the case of the current research, service providers' experiences of an ongoing lack of collaboration, lack of involvement, and "resource guarding" on the part of child welfare systems provide an avenue for important questions raised by this theory. Does this lack of social equity exhibited by the child welfare system's attitude and actions towards service providers, and therefore the child trafficking population itself, represent a just society? The United States has set forth both federal and state legislation criminalizing child trafficking, yet as a governmental agency and major source of support for victims, the child welfare system is viewed as resistant, unmotivated, and uncooperative in funding services and becoming directly involved with this population in general. Is the child welfare system designed to value human rights? Limitations and Future Research As with any study, there are limitations that should be discussed related to the current research. Limitations in this study related to a lack of prolonged exposure in the field, a single researcher coding the data without the input of others, and the absence of an outside reviewer. Each of these limitations has the potential to lead to an incorrect description of the experiences of service providers. Logical next steps for further research in this area are in-depth, exploratory interviews with caseworkers and administrators working within the child welfare system itself. This data collection effort is a vital next step in understanding the world in which child welfare system operates, which includes experiences in working with service 89 providers, and in turn, juvenile justice and legislative entities that establish mandates within which the child welfare system must operate. Further, the specific challenges and opportunities in serving the child trafficking population within the child welfare system should be further explored. Conclusion The goal of this study was to gain an in-depth understanding of the observations, experiences, and opinions of service providers working with victims of child trafficking. This study did not specifically set out to discuss the role and interaction of the child welfare system in the lives of these victims. However, as a result of these in-depth interviews, a significant theme involving the role and interaction of child welfare with victims of child trafficking and service providers was consistently discussed throughout the research interviews. It is the hope of the researcher that the summary of provider concerns in this article will serve as the beginning to an ongoing conversation about the role of child welfare systems throughout the United States as it pertains to child trafficking with an equal emphasis on the goals and needs of those working within those entities. References Barusch, A., Gringeri, C., & George, M. (2011). 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Retrieved from AECF website: http://www.aecf.org/~/media /Pubs/Topics/Child%20Welfare%20Permanence/Permanence /WhenChildWelfareWorks/WhenChildWelfareWorksWorkingPaper.pdf Charmaz, K. (2010). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage. Clawson, H. J., Dutch, N., Solomon, A., & Grace, L. G. (2009). Human trafficking into and within the United States: A review of the literature [Report]. Retrieved from U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation website: http://aspe.hhs.gov/hsp/07/humantrafficking /LitRev/ Courtney, M., Flynn, R., & Beaupre, J. (2013). Overview of out of home care in the USA and Canada. Psychosocial Intervention, 22, 163-173. Creswell, J. (2007). Qualitative inquiry and research design: Choosing among five approaches. Thousand Oaks, CA: Sage. Estes, R., & Weiner, N. (2001). The commercial sexual exploitation of children in the United States, Canada and Mexico. Philadelphia, PA: University of Pennsylvania School of Social Work. Fong. R., & Berger Cardoso, J. (2010). Child human trafficking victims: Challenges for the child welfare system. Evaluation and Program Planning, 33, 311-316. Goździak, E. (2008). On challenges, dilemmas, and opportunities in studying trafficked children. Anthropological Quarterly, 81(4), 903-923. Goździak, E., & MacDonnell, M. (2007). Closing the gaps: The need to improve identification and services to child victims of trafficking. Human Organization, 66(2), 171-184. Herman, J. (1997). Trauma and recovery: The aftermath of violence-from domestic abuse to political terror. New York, NY: Basic Books. Jootun, D., Marland, G. R., & McGhee, G. (2009). Promoting rigour in qualitative research. Nursing Standard, 23(23), 42-46. 91 Jordan, J., Patel, B., & Rapp, L. (2013). 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"Unsatisfactory saturation": A critical exploration of the notion of saturation sample size in qualitative research. Qualitative Research, 13(2), 190-197. Rawls, J. (1993). The law of peoples. Critical Inquiry, 20(1), 36-68. Schauer, E., & Wheaton, E. (2006). Sex trafficking into the United States: A literature review. Criminal Justice Review, 31(2), 146-169. Smith, L. A., Healy Vardaman, S., & Snow. M. A. (2009). The national report on domestic minor sex trafficking: America's prostituted children. Retrieved from the Shared Hope International website: http://sharedhope.org/wp-content/uploads /2012/09/SHI_National_Report_on_DMST_2009.pdf Todres, J. (2012). Assessing public health strategies for advancing child protection: Human trafficking as a case study. Journal of Law & Policy, 21(1), 93-112. Tyldum, G. (2010). Limitations in research on human trafficking. International Migration, 48(5), 1-13. West, A. (2014). What the helper knows: Victim resistance and the experiences of service providers working with child trafficking victims. Unpublished manuscript. CHAPTER 5 CONCLUSION Overview Child trafficking in the United States, including both labor and sex trafficking, are understudied and not particularly well understood within the social work literature. Without added information, social workers run the risk of being unprepared for the needs of trafficked youth and offering misguided supports and interventions. This dissertation aimed to address these risks by exploring how the concept of child trafficking is understood by others, considering the experiences of those interacting with this population, and forming theoretical interpretations that may be helpful in shaping services and policy on child trafficking within the field of social work. The trafficking of children is an underground and criminal phenomenon that adds to the difficulty in conducting research in this area. Victims are hesitant to come forward due to threats and fear of violence and retaliation creating a void of research participants, victims are often mistrusting of others, and victims are hesitant to share their experiences with others due to shame and the fear of judgment from others. As a result, there are gaps in the existing research that leave us with many unanswered questions. How do we go about understanding, defining, and conceptualizing child trafficking? How can we best serve this population? How can research and policy aid social workers and other professionals working with this population? 93 Due to a lack of information related to victims of child trafficking, it is difficult to design and implement the services needed. In addition, victims of child trafficking differ in their specific needs as compared to victims of traditional abuse. Therefore, interventions designed for the treatment of trauma, substance abuse, or ongoing mental health issues, such as depression, may require different services all together, or approaches made through non-traditional means in an effort to effectively treat victims of child trafficking. Currently, providers are attempting to provide services based on their own professional experiences with this population while lacking an organized or datainformed outline of what interventions are needed and how they can best be delivered. Conducting additional research in this area will also help in guiding crucial systems, such as child welfare and juvenile justice, as to how their involvement on a macro level can be helpful in aiding to the recovery of victims. The research conducted for this dissertation addressed some of these needs by further understanding the concept of child trafficking, gaining an intimate understanding of the experiences of service providers, as well as focusing on the involvement of outside macro systems, such as child welfare. Theoretical Considerations As addressed in previous chapters, the theories of Intersectionality and Theory of Justice were utilized in guiding and reflecting upon the present research. It is hoped that these discussions have helped to both frame concepts within a larger context while also allowing for the development of questions and further inquiry in instances when concepts fail to conform to the frames developed. 94 In the discussion of Theory of Justice and its application to the phenomenon of child trafficking, several points were elaborated on primarily related to this theory's discussion of a fair and just society. More generalized points of this theory would point to the monetary struggles that providers encounter over funding for services as an indication of the lack of equality present in concrete services as well as a lack of regard towards the phenomenon in general. In addition, within Rawls' theory, he emphasizes that as an output of fairness, individuals must not only have an equal footing to resources but to also interact with other citizens as equals (Mandle, 2009). Related to child trafficking, this social equality is vital yet described as lacking and as is communicated by providers through their discussions around the lack of empowerment experienced by victims. Finally, the resistance of other social entities, such as child welfare, to become involved with this population serves to highlight this social inequality. A framework, such as Intersectionality, that focuses on the human experience as filtered through a screen of oppression on a multitude of levels allowed for a deeper understanding of these inequalities in a variety of situations. One of these situations included the concept of "good and bad victim" and the social judgment, that this population faces from those who expect victims to act and behave in a prescribed manner. Created out of such social judgment, another level of oppression emerges that adds to the unique human experience of victims of child trafficking in addition to already oppressive categories such as gender and socio-economic status for example. This theory helps to further examine existing themes from the research by focusing on the relationship between oppression and the lived experience of child trafficking victims. 95 Concept of Child Trafficking An exploration of the child trafficking phenomenon as experienced by others requires an understanding of what the phenomenon is. How is the phenomenon communicated and understood between groups and individuals? What are related ideas? What are conditions that are conducive to its existence? How do we recognize its effects? These questions and many more require a response in identifying what the phenomenon of child trafficking is. Without exploring these questions prior to forming future theory, we are beginning our journey from a point of disadvantage. The concept analysis conducted in this dissertation addressed just these questions and formed a common ground in moving forward when speaking with service providers interacting with victims of child trafficking. The analysis also created the solid backbone required for the development of theory among those interactions. Service Provider Experiences and Victim Resistance In Chapter 3 of this dissertation, in understanding both the inherent and diverse thoughts and opinions of service providers working with victims of child trafficking, this study explored the experiences and observations of those working with this population. A theme commonly discussed was that of "victim resistance." The term "victim resistance" was created based on the responses and actions of victims that providers understood and experienced in their efforts to help when victims would refuse services, run away, or avoid providers in general. Providers talked about the need to discuss and acknowledge victim resistance in order to create more specialized approaches and interventions. 96 Service Provider Experiences and Child Welfare In the United States, the child welfare system is charged with protecting children from neglect and abuse. Service providers in this study (Chapter 4) shared their experiences and observations in working with the child welfare system. They presented concerns they had related to a lack of identification of victims on the part of child welfare workers, the overall relationship with child welfare, differing approaches to interventions, and funding struggles between child welfare and themselves. This article also discussed the financial and legislative constraints placed up on the child welfare system, which lend themselves to the concerns voiced by service providers. Future Community Responses Victim resistance The development of recommendations for addressing the perceived resistance of victims of child trafficking would ideally be addressed through a multidisciplinary approach with the involvement of multiple systems interacting on the micro, mezzo, and macro levels of this issue. Beginning with an increased awareness among professionals of the existence of victim resistance, providers can then begin to assess the reasons for resistance or be prepared when encountering it and how to respond. Awareness can be fostered through continued conversations between providers in multiple fields and roles with the goal of preparing responses in both direct, face-to-face interactions as well as indirect levels that would focus on program development and policy formation. Understanding that there are dynamics present that add to this resistance, such as social judgment, identifying with the trafficker, a felt sense of lack of empowerment, hesitancy to trust providers, and failing to view themselves as victims of trafficking in 97 general helps to provide professionals with a foundation to build future interventions on. Without knowledge of these elements of resistance, professionals in direct practice as well as those engaged in policy and service development will not be prepared to address or respond to the specific needs of this population. Possessing a proficient understanding of trauma-informed systems of care, as well as complex trauma in particular, will aid professionals immensely in their work with victims of child trafficking. As with understanding the dynamics of resistance, understanding the impact of trauma and its related symptomatology will provide administrators and practitioners alike with powerful information in producing effective means of approaching their work with victims. This knowledge will help professionals recognize and respond to the needs of victims in a holistic manner in which all aspects of their care (i.e., policies, practice, knowledge base, organizational culture) are guided by shared principles. Children who are actively involved in trafficking situations may not identify themselves as victims or may actively avoid interventions. In these situations, there may seem to be little opportunity in focusing on self-determination when safety is the number one priority and children must be forcibly removed or placed in secured higher levels of care for their own protection. However, self-determination is a concept that can be adapted to situations that are more restrictive as well. Providers discussed using creative means to encourage children to make their own decisions whenever possible no matter how small or trivial such decisions appeared. More significant decisions, such as when and how to "tell their story," taking their time in trusting others, and choosing who to 98 include in their treatment process can have a powerful impact on children who have had little control over their environment in general. Child welfare Bridging the divide between service providers and the child welfare system is an important task that must be undertaken by all parties working with victims of child trafficking. Increasing awareness pertaining to child trafficking within the child welfare system is a prime objective. Efforts to increase the awareness of child welfare workers directly in the field, as well as systemic discussions on all levels of the child welfare system, should be an active component included in meeting this objective. Rather than treating trafficking situations as an alternate form of child abuse, the automatic screening of referrals for elements of trafficking can be integrated into the intake and investigative processes conducted by child welfare workers from the beginning. Training and familiarization with elements commonly found in child trafficking situations would enable child welfare workers to readily identify concerning situations. Of vital importance is addressing the requests made for higher levels of care and the ensuing struggles related to funding. If the child welfare system is to remain the gateway entity to accessing residential treatment, how can community providers still remain active in this decision-making process? Are there avenues for providers to share their experiences and expertise with children that would assist the child welfare system in formulating recommendations for victims? In forming a collaborative model related to funding decisions, it may be beneficial for child welfare supervisors to engage the community while presenting the constraints of their system as well as the opportunities for creative collaboration when possible. Likewise, these conversations may also center 99 around utilization management by accessing provider expertise in determining when a child can safely remain in a community-based setting, avoiding costly higher levels of care. Examples such as these could certainly be expanded upon and explored in further detail by all parties involved. Building a collaborative relationship among all providers involved in the movement to end child trafficking is imperative. Open communication regarding the philosophical and mandated charges of the child welfare system would provide a reference point for others in understanding what the child welfare system can and can not provide. Just as differing community providers have their own philosophies and abilities to address child trafficking, so does the child welfare system. Open communication would also aid in ongoing discussions related to issues such as, sharing resources, delivering services, and program utilization. Finally, integrating a means for evaluating the collaboration with the goal of replicating successes and problem solving when barriers present themselves can provide ongoing support for the growth of the collaboration. Practice, Policy, and Future Research One of the goals of the research conducted was to bridge the elements learned from the experiences of service providers working with child trafficking victims to the current efforts being made in the area of practice within the field of social work, in addition to informing policy and future research in social work. Combined, the studies in this dissertation generate a deeper understanding of the concept of child trafficking, how victims relate to and participate in treatment interventions, and how the child welfare 100 system interacts with the population of service providers working with trafficked children. Clinical Implications Related to the area of practice are specific themes that developed, such as victim resistance, in the interactions that providers had with victims. Recognizing the various topics related to the resistance of child victims is vital to providers working with this population. Dynamics between shame, societal judgment, mistrust of adults, fear, perceived oppression, and social rejection all contribute to the lack of victim participation or outright refusal to engage in treatment. When services are then mandated and require a victim to participate in treatment despite his/her own preference, such as in the instance of being mandated to enter a residential treatment setting, providers run the risk of further marginalizing and oppressing this exploited population. However, many providers in this research also believed that a secured setting in residential treatment was still clinically indicated due to running away behaviors or severe behavioral concerns even though it compromised the empowerment of victims. Creating a mechanism for victims to feel empowered even in a mandated setting was suggested. Developing a relationship and trust with the victim was ultimately the most frequently discussed dynamic that providers believed to pave the way for further treatment activities. Trust building was described as the most significant building block in effecting change related to resistance. The concepts of empowerment and trust are just two examples of the clinical topics that those in clinical settings can integrate into designing and providing services to victims of child trafficking. 101 Policy Implications The research in this dissertation included a number of conversations with participants that directly addressed the role of policy and its connection to the lives of child trafficking victims and the services provided to them. Two of these areas include the involvement of law enforcement and child welfare. The role of law enforcement is critical in identifying and intervening in situations that may entail child trafficking. In some states, child prostitution is still prosecuted despite the definition of child sex trafficking provided in the Trafficking Victims Protection Act enacted on a federal level that reiterates that any child engaged in a commercial sex act is automatically determined to be a victim of sex trafficking. Rather than prosecuting the crime of prostitution, states within the U.S. are adjusting their legislation to eradicate the concept of child prostitution and are instead creating "safe harbor" laws that clearly indicate that children are not criminals if involved in trafficking situations. These safe harbor acts additionally allow for law enforcement personnel to intervene in child trafficking situations with the aim of referring the victim for services through a human services avenue rather than entering the juvenile justice system. Due to the direct contact law enforcement has with potential victims, it is extremely important that they be provided with the necessary training and knowledge base required to correctly identify child trafficking activities or situations that suggest children are being exploited by others. The role of child welfare and policy related to their involvement with victims of child trafficking requires further discussion and research. However, even at this phase, the research conducted for this dissertation pointed to several needs among victims and service providers that policy could address. Increasing the awareness of caseworkers, 102 educating caseworkers about characteristics and attributes of trafficking, and the proper identification of victims are all policy-driven changes that would be required in working with this population. Defining the role of the child welfare system as a whole includes who maintains legal custody over the victim, under what circumstances does the system become involved in providing for basic needs and/or treatment, when is reunification with the family of origin indicated, how are funds acquired and distributed for services and should this originate from the child welfare system, and how can child welfare entities reinforce prevention and interventions for this population. Future Research The research area of child trafficking is in need of additional and ongoing research in many areas. Based upon the research conducted in this dissertation, a logical next step for future research would be an extension of the completed research related to service providers and entail qualitative research specific to the experiences, observations, and opinions of child welfare workers as well. It would be especially important to understand the knowledge base of caseworkers related to trafficking, professional interactions with victims, and their experiences with service providers and victims alike. Due to the influential role that the child welfare system takes on related to the direction of treatment and the funding for treatment, it is critical that this population of providers be explored and understood both from a macro and micro perspective. Missing within the current literature are studies that include the direct participation of victims of child trafficking. Both quantitative and qualitative forms of research will encounter several hurdles such as gaining the approval of an institutional review board based on the age and vulnerability of the victims involved as well as finding 103 victims to participate in the study. Due to the underground nature of this phenomenon, victims are not easily found for the purpose of recruitment, and due to the nature of their victimization may prefer to forego questions related to their past experiences altogether. These barriers create unique challenges for future research in this area that must be addressed prior to research being conducted. Future directions for research include the evaluation of programs providing service to child victims and specific trauma-informed interventions employed while working with victims in a variety of treatment settings. References Lovett, F. (2011). Rawls's a theory of justice. New York, NY: Continuum International. Mandle, J. (2009). Rawls's a theory of justice: An introduction. Cambridge, MA: University Press. McCall, L. (2005). The complexity of intersectionality. Signs, 30(3), 1771-1800. Rawls, J. (1993). The law of peoples. Critical Inquiry, 20(1), 36-68. APPENDIX A SERVICE PROVIDER INTERVIEW GUIDE 1. How extensive do you think human trafficking is? a. Why? b. How would you identify a person who has been trafficked? c. What are their strengths? 2. What do you think victims of human trafficking want from services? a. Why? b. Would you describe what that would look like? 3. What is the biggest struggle of agencies in trying to help victims? a. Why? 4. What is the biggest barrier to victims receiving services? a. Why? 5. What resources do professionals need in order to effectively help victims? 6. Do you think current services have been successful in helping victims? a. Which services? 7. Describe the most difficult part of your job. a. Why is that difficult? b. How do you know you have been successful? 8. What do you think victims struggle with the most after they are out of their previous situations? a. Would you give an example for me? APPENDIX B SERVICE PROVIDER SURVEY DEMOGRAPHICS 1. Gender 2. Ethnicity 3. Educational background 4. Time in position 5. Time in field of trafficking 6. Type of agency (shelter, advocacy, legal, treatment, etc.) 7. Number of yearly contacts with trafficking victims 8. Funding source 9. Funding Level